{ "hospital_name": "Rumford Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Rumford Hospital" ], "hospital_address": [ "420 Franklin Street, Rumford, ME 04276" ], "license_information": { "license_number": "39768", "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": [ "1205991122" ], "standard_charge_information": [ { "description": "US Transplanted Kidney Doppler", "code_information": [ { "code": "76776", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1250.25, "discounted_cash": 362.0, "minimum": 362.5725, "maximum": 1133.9768, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 420.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "SO KRAS Mutation Detect1", "code_information": [ { "code": "81275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 677.75, "discounted_cash": 196.0, "minimum": 196.5475, "maximum": 677.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 677.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 677.75 } ] } ] }, { "description": "VIRAL MENINGITIS WITH CCMCC", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 22605.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22605.37 } ] } ] }, { "description": "Plasma Added - P9059 - 3001002 - 3001002", "code_information": [ { "code": "P9059", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.0, "minimum": 78.01, "maximum": 243.983, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 538.0, "10th_percentile": 538.0, "90th_percentile": 538.0, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 44168.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44168.59 } ] } ] }, { "description": ".Endomysial Ab, IgA w/Reflex", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 42.0, "minimum": 42.485, "maximum": 132.8755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 109.73, "10th_percentile": 104.89, "90th_percentile": 155.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.17, "10th_percentile": 55.17, "90th_percentile": 55.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.15, "10th_percentile": 53.15, "90th_percentile": 147.83, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 93.32, "90th_percentile": 93.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.15, "10th_percentile": 115.15, "90th_percentile": 120.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 146.5, "10th_percentile": 146.5, "90th_percentile": 146.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 244.13, "10th_percentile": 244.13, "90th_percentile": 244.13, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 153.25, "10th_percentile": 50.0, "90th_percentile": 356.5, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.04, "10th_percentile": 46.88, "90th_percentile": 100.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.8, "10th_percentile": 100.8, "90th_percentile": 285.71, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.14, "10th_percentile": 46.88, "90th_percentile": 115.35, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.04, "10th_percentile": 49.04, "90th_percentile": 49.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 99.44, "10th_percentile": 57.2, "90th_percentile": 100.8, "count": "1 through 10" } ] } ] }, { "description": "US Non Obstet Limited Transvag", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 574.5, "discounted_cash": 166.0, "minimum": 166.605, "maximum": 574.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 388.07, "10th_percentile": 388.07, "90th_percentile": 388.07, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 195.12, "10th_percentile": 195.12, "90th_percentile": 195.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 336.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 199.24, "10th_percentile": 187.97, "90th_percentile": 199.24, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 365.96, "10th_percentile": 365.96, "90th_percentile": 365.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 451.56, "10th_percentile": 434.2, "90th_percentile": 451.56, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 574.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 420.05, "10th_percentile": 420.05, "90th_percentile": 420.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 574.5, "10th_percentile": 542.0, "90th_percentile": 574.5, "count": "67" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 496.47, "10th_percentile": 496.47, "90th_percentile": 496.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 173.44, "90th_percentile": 200.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 183.84, "90th_percentile": 183.84, "count": "1 through 10" } ] } ] }, { "description": "Echo 2D Comprehensive w/Contrast - C8929 - 5001009", "code_information": [ { "code": "C8929", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.0, "minimum": 735.15, "maximum": 2299.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 912.6, "10th_percentile": 912.6, "90th_percentile": 912.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 879.14, "10th_percentile": 879.14, "90th_percentile": 879.14, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 671.33, "10th_percentile": 644.13, "90th_percentile": 737.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 162.24, "10th_percentile": 162.24, "90th_percentile": 187.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.24, "10th_percentile": 25.0, "90th_percentile": 291.1, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "1 through 10" } ] } ] }, { "description": "XR Arthrogram Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 253.0, "minimum": 253.025, "maximum": 854.4012, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 285.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 350.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 280.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.4 } ] } ] }, { "description": "XR Ankle Left 3 Views", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.75, "discounted_cash": 112.0, "minimum": 85.8, "maximum": 350.7822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 261.16, "10th_percentile": 261.16, "90th_percentile": 261.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.31, "10th_percentile": 131.31, "90th_percentile": 139.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.13, "10th_percentile": 126.5, "90th_percentile": 134.13, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 246.36, "10th_percentile": 246.36, "90th_percentile": 246.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 303.99, "10th_percentile": 303.99, "90th_percentile": 303.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 123.76, "90th_percentile": 123.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 386.75, "10th_percentile": 364.75, "90th_percentile": 386.75, "count": "85" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 123.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 334.11, "10th_percentile": 123.76, "90th_percentile": 350.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 134.96, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 124.02, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.72, "90th_percentile": 124.02, "count": "1 through 10" } ] } ] }, { "description": "77001 FAC FLUOROSCOPC GUIDANCE CVAD", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.0, "discounted_cash": 169.0, "minimum": 169.36, "maximum": 584.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 342.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 420.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 336.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 584.0 } ] } ] }, { "description": "PT Apply Multilay Comprs Lwr Leg Unit", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.0, "discounted_cash": 139.0, "minimum": 95.0, "maximum": 437.174, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18432.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18432.07 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 20543.229, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 28083.52, "10th_percentile": 28083.52, "90th_percentile": 28083.52, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14951.96 } ] } ] }, { "description": "Stool Additional Pathogen, each plate", "code_information": [ { "code": "87046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.25, "discounted_cash": 7.0, "minimum": 7.6125, "maximum": 26.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.17, "10th_percentile": 17.17, "90th_percentile": 18.21, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 39.65, "10th_percentile": 39.65, "90th_percentile": 39.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.16, "10th_percentile": 20.16, "90th_percentile": 20.16, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 38.36, "10th_percentile": 38.36, "90th_percentile": 38.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 52.5, "10th_percentile": 49.5, "90th_percentile": 52.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.8, "10th_percentile": 15.84, "90th_percentile": 18.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 16.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.83, "10th_percentile": 16.8, "90th_percentile": 18.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.8, "10th_percentile": 16.8, "90th_percentile": 16.8, "count": "1 through 10" } ] } ] }, { "description": "Whirlpool Therapy OT", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.75, "discounted_cash": 35.0, "minimum": 35.5975, "maximum": 111.3342, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 10783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10783.38 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC", "code_information": [ { "code": "843", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 23516.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23516.66 } ] } ] }, { "description": "FINGER ABSCESS SIMP FAC", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 353.0, "discounted_cash": 102.0, "minimum": 102.37, "maximum": 320.171, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 271.1, "10th_percentile": 271.1, "90th_percentile": 271.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 353.0, "10th_percentile": 353.0, "90th_percentile": 353.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.96, "10th_percentile": 112.96, "90th_percentile": 112.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.96, "10th_percentile": 112.96, "90th_percentile": 112.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.96, "10th_percentile": 112.96, "90th_percentile": 112.96, "count": "1 through 10" } ] } ] }, { "description": "96416 CHMO ADMIN IV INFUS 1-8HR - 96416 - 7336416", "code_information": [ { "code": "96416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.0, "discounted_cash": 367.0, "minimum": 367.43, "maximum": 1149.169, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 811.39, "10th_percentile": 649.08, "90th_percentile": 811.39, "count": "11" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1206.75, "10th_percentile": 1206.75, "90th_percentile": 1206.75, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19503.0, "minimum": 19503.14, "maximum": 79352.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 79352.8 } ] } ] }, { "description": "88108 AP Bill Non-Gyn Cytology Concentration Technique", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.5, "discounted_cash": 58.0, "minimum": 58.145, "maximum": 200.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.53, "10th_percentile": 69.53, "90th_percentile": 69.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.55, "10th_percentile": 24.55, "90th_percentile": 24.55, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.17, "10th_percentile": 68.17, "90th_percentile": 68.17, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21969.0, "minimum": 21969.05, "maximum": 50608.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50608.91 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "708", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 18086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18086.65 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH MCC", "code_information": [ { "code": "385", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 18653.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18653.7 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "352", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 13767.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13767.17 } ] } ] }, { "description": "Rad Ther Iodine 125 per MCI", "code_information": [ { "code": "A9527", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "minimum": 46.3275, "maximum": 159.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.75 } ] } ] }, { "description": "SYNCOPE AND COLLAPSE", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 11127.654, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5380.18, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10275.27 } ] } ] }, { "description": "75831 FAC VEIN X-RAY KIDNEY", "code_information": [ { "code": "75831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8686.0, "discounted_cash": 2518.0, "minimum": 580.8918, "maximum": 7878.202, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 580.89 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6854.6727, "maximum": 11554.983, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10719.1, "10th_percentile": 10719.1, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11506.04 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITHOUT MCC", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10558.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10558.21 } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CCMCC", "code_information": [ { "code": "488", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 20853.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20853.53 } ] } ] }, { "description": "SLP Pharyngeal Swallow Eval Units", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.0, "discounted_cash": 143.0, "minimum": 95.0, "maximum": 449.872, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 496.0, "10th_percentile": 496.0, "90th_percentile": 496.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 57.57, "10th_percentile": 57.57, "90th_percentile": 57.57, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.72, "10th_percentile": 158.72, "90th_percentile": 158.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.7, "10th_percentile": 36.7, "90th_percentile": 36.7, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.72, "10th_percentile": 158.72, "90th_percentile": 158.72, "count": "1 through 10" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC", "code_information": [ { "code": "353", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 34211.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34211.62 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 17611.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17611.56 } ] } ] }, { "description": "Vitamin B12 Binding Capacity", "code_information": [ { "code": "82608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 50.0, "minimum": 50.17, "maximum": 156.911, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.75 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 14106.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14106.69 } ] } ] }, { "description": "Cytomegalovirus Qual. by PCR", "code_information": [ { "code": "87496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 113.0, "minimum": 113.97, "maximum": 356.451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.64, "10th_percentile": 118.64, "90th_percentile": 118.64, "count": "1 through 10" } ] } ] }, { "description": "XR TM Joints Unilateral", "code_information": [ { "code": "70328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.25, "discounted_cash": 89.0, "minimum": 80.1, "maximum": 281.3967, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 } ] } ] }, { "description": "Alk Phos, Total", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 19.0, "minimum": 19.285, "maximum": 60.3155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.94, "10th_percentile": 23.94, "90th_percentile": 23.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.06, "10th_percentile": 23.06, "90th_percentile": 23.06, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 42.36, "10th_percentile": 42.36, "90th_percentile": 42.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 66.5, "10th_percentile": 48.75, "90th_percentile": 66.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.28, "10th_percentile": 21.28, "90th_percentile": 22.61, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 54447.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54447.4 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 22742.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22742.12 } ] } ] }, { "description": "Glucagon Level", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.5, "discounted_cash": 57.0, "minimum": 57.275, "maximum": 179.1325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.48 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC", "code_information": [ { "code": "814", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 25071.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25071.62 } ] } ] }, { "description": "EBV Early Ab, IgG", "code_information": [ { "code": "86663", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.25, "discounted_cash": 47.0, "minimum": 47.9225, "maximum": 149.8818, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 106.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.63 } ] } ] }, { "description": "Histamine, Urine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.5, "discounted_cash": 29.0, "minimum": 29.435, "maximum": 101.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 101.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.5 } ] } ] }, { "description": "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY", "code_information": [ { "code": "789", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 21246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21246.1 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 67554.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67554.39 } ] } ] }, { "description": "MRI Angio Lower Ext Left wo + w Contrast", "code_information": [ { "code": "73725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3767.0, "discounted_cash": 1092.0, "minimum": 900.0, "maximum": 3416.669, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1696.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2210.68 } ] } ] }, { "description": "C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 329.5, "discounted_cash": 95.0, "minimum": 95.555, "maximum": 298.8565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.62, "10th_percentile": 118.62, "90th_percentile": 118.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 329.5, "10th_percentile": 329.5, "90th_percentile": 329.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 112.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 121.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 121.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.44, "10th_percentile": 105.44, "90th_percentile": 105.44, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 18481.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18481.58 } ] } ] }, { "description": "IR Radiopharm TX 79445", "code_information": [ { "code": "79445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 728.75, "discounted_cash": 211.0, "minimum": 211.3375, "maximum": 728.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 409.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 502.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 401.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.75 } ] } ] }, { "description": "XR Cholecystogram", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.5, "discounted_cash": 197.0, "minimum": 188.78, "maximum": 617.2135, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 192.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 235.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 188.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.16 } ] } ] }, { "description": "PENIS PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "710", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 16518.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16518.72 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "470", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 22739.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22739.76 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITHOUT MCC", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17517.7859, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16521.08, "10th_percentile": 16521.08, "90th_percentile": 16521.08, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12020.04 } ] } ] }, { "description": "XR Femur Right 1 View", "code_information": [ { "code": "73551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.25, "discounted_cash": 101.0, "minimum": 101.5725, "maximum": 317.6768, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.08, "10th_percentile": 112.08, "90th_percentile": 112.08, "count": "1 through 10" } ] } ] }, { "description": "Primidone Level", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.5, "discounted_cash": 39.0, "minimum": 39.585, "maximum": 136.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 134.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.2, "10th_percentile": 41.2, "90th_percentile": 43.68, "count": "1 through 10" } ] } ] }, { "description": "Luteinizing Hormone, Male", "code_information": [ { "code": "83002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 231.0, "discounted_cash": 66.0, "minimum": 66.99, "maximum": 209.517, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 152.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 149.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.69 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13597.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13597.41 } ] } ] }, { "description": "IR Trnscath Biopsy S+I", "code_information": [ { "code": "75970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2804.5, "discounted_cash": 813.0, "minimum": 813.305, "maximum": 2804.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1754.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2150.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1720.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2804.5 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 44063.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44063.67 } ] } ] }, { "description": "DRAIN SCROTAL ABSCESS FAC", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 911.25, "discounted_cash": 264.0, "minimum": 264.2625, "maximum": 826.5037, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 291.6, "10th_percentile": 291.6, "90th_percentile": 291.6, "count": "1 through 10" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19054.0, "minimum": 19054.79, "maximum": 133590.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 133590.36 } ] } ] }, { "description": "NM Thyroid Mets Scan Whole Body", "code_information": [ { "code": "78018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1711.75, "discounted_cash": 496.0, "minimum": 496.4075, "maximum": 1711.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1072.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1313.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1051.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1711.75 } ] } ] }, { "description": "NM Lung Ventilation Only", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.25, "discounted_cash": 206.0, "minimum": 206.8425, "maximum": 713.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 612.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 600.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.25 } ] } ] }, { "description": "Urine Calcium", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 25.0, "minimum": 25.7375, "maximum": 80.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 46.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.03, "10th_percentile": 6.03, "90th_percentile": 6.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CCMCC", "code_information": [ { "code": "734", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 25110.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25110.53 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23314.0, "minimum": 23314.1, "maximum": 99379.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99379.92 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 23276.691, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17314.47 } ] } ] }, { "description": "XR Leg Lower Left 2 Views", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394.75, "discounted_cash": 114.0, "minimum": 71.49, "maximum": 358.0383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 266.71, "10th_percentile": 266.71, "90th_percentile": 266.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.11, "10th_percentile": 142.11, "90th_percentile": 142.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.18, "10th_percentile": 129.18, "90th_percentile": 136.9, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 251.46, "10th_percentile": 251.46, "90th_percentile": 305.45, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 310.27, "10th_percentile": 310.27, "90th_percentile": 310.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 126.32, "90th_percentile": 126.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 372.5, "10th_percentile": 372.5, "90th_percentile": 394.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 119.2, "90th_percentile": 126.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 341.21, "10th_percentile": 126.32, "90th_percentile": 358.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.32, "10th_percentile": 126.32, "90th_percentile": 126.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.2, "10th_percentile": 119.2, "90th_percentile": 126.65, "count": "1 through 10" } ] } ] }, { "description": "PTH Intact - Sendout", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.5, "discounted_cash": 78.0, "minimum": 78.445, "maximum": 270.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 193.68, "10th_percentile": 193.68, "90th_percentile": 193.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.38, "10th_percentile": 97.38, "90th_percentile": 97.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.81, "10th_percentile": 93.81, "90th_percentile": 93.81, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 172.31, "10th_percentile": 172.31, "90th_percentile": 172.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 216.7, "10th_percentile": 212.61, "90th_percentile": 216.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.96, "10th_percentile": 93.48, "90th_percentile": 270.5, "count": "15" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 270.5, "10th_percentile": 270.5, "90th_percentile": 270.5, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 245.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 86.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.56, "10th_percentile": 86.56, "90th_percentile": 91.97, "count": "1 through 10" } ] } ] }, { "description": "Acid Elution", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 566.0, "discounted_cash": 164.0, "minimum": 164.14, "maximum": 513.362, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.29 } ] } ] }, { "description": "HC (SUP SHELL C1788) PORT INDWELLING", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 519.4625, "maximum": 1624.6637, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1068.35, "10th_percentile": 1068.35, "90th_percentile": 1068.35, "count": "1 through 10" } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 1%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "55150016209", "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "OTA MMT, Total Body Without Hand Units", "code_information": [ { "code": "95833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 37.0, "minimum": 37.99, "maximum": 118.817, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "76000 FAC FLUORO LESS THAN 1 HOUR", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 530.5, "discounted_cash": 153.0, "minimum": 153.845, "maximum": 481.1635, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 330.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.84 } ] } ] }, { "description": "Bill Platelet Antibody Screen", "code_information": [ { "code": "86022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 856.0, "discounted_cash": 248.0, "minimum": 148.63, "maximum": 776.392, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 148.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.3 } ] } ] }, { "description": "L/S Ratio Amniotic Fluid", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.5, "discounted_cash": 73.0, "minimum": 73.515, "maximum": 229.9245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 177.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.86 } ] } ] }, { "description": "Bill Chr Anal POC Culture", "code_information": [ { "code": "88233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 926.5, "discounted_cash": 268.0, "minimum": 268.685, "maximum": 926.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 889.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 711.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 926.5 } ] } ] }, { "description": "XR Knee Left 3 Views", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.5, "discounted_cash": 130.0, "minimum": 95.8, "maximum": 409.5105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 346.75, "10th_percentile": 330.15, "90th_percentile": 349.91, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.54, "10th_percentile": 153.36, "90th_percentile": 162.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 95.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.74, "10th_percentile": 147.74, "90th_percentile": 156.58, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 287.61, "10th_percentile": 271.36, "90th_percentile": 349.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 341.27, "10th_percentile": 341.27, "90th_percentile": 341.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 144.48, "90th_percentile": 158.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 451.5, "10th_percentile": 426.0, "90th_percentile": 451.5, "count": "54" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 409.51, "10th_percentile": 360.88, "90th_percentile": 780.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 157.62, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.48, "10th_percentile": 136.32, "90th_percentile": 144.84, "count": "12" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 8041.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8041.26 } ] } ] }, { "description": "IV Push Each Addl Same Med", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.75, "discounted_cash": 95.0, "minimum": 95.3375, "maximum": 298.1762, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 470.77, "10th_percentile": 235.39, "90th_percentile": 767.55, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.35, "10th_percentile": 118.35, "90th_percentile": 118.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.02, "10th_percentile": 114.02, "90th_percentile": 342.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 328.75, "10th_percentile": 253.66, "90th_percentile": 657.5, "count": "14" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 328.75, "10th_percentile": 328.75, "90th_percentile": 986.25, "count": "58" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.78, "10th_percentile": 105.2, "90th_percentile": 335.33, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 262.77, "10th_percentile": 105.2, "90th_percentile": 301.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 315.6, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 335.33, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 210.4, "count": "1 through 10" } ] } ] }, { "description": "Zinc Level", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 26.0, "minimum": 26.39, "maximum": 91.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 65.16, "10th_percentile": 65.16, "90th_percentile": 65.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 72.9, "10th_percentile": 71.53, "90th_percentile": 72.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 91.0, "10th_percentile": 91.0, "90th_percentile": 91.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.12, "10th_percentile": 29.12, "90th_percentile": 92.96, "count": "1 through 10" } ] } ] }, { "description": "CT Angio Lower Ext LT w+wo Contrast", "code_information": [ { "code": "73706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1681.0, "discounted_cash": 487.0, "minimum": 487.49, "maximum": 1681.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1394.33 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1585.75, "10th_percentile": 1585.75, "90th_percentile": 1585.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1267.49, "10th_percentile": 1267.49, "90th_percentile": 1267.49, "count": "1 through 10" } ] } ] }, { "description": "Genta", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.25, "discounted_cash": 69.0, "minimum": 69.0925, "maximum": 216.0927, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 132.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.85 } ] } ] }, { "description": "SIM REP EXT 20.1-30 FAC", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.0, "discounted_cash": 121.0, "minimum": 121.22, "maximum": 379.126, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.0, "10th_percentile": 398.0, "90th_percentile": 398.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 364.57, "10th_percentile": 364.57, "90th_percentile": 364.57, "count": "1 through 10" } ] } ] }, { "description": "Allergen, Apple IgE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.25, "discounted_cash": 13.0, "minimum": 13.9925, "maximum": 48.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1105.34, "10th_percentile": 1105.34, "90th_percentile": 1105.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 42.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 153.68, "10th_percentile": 153.68, "90th_percentile": 153.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 779.75, "10th_percentile": 48.25, "90th_percentile": 1439.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 450.88, "10th_percentile": 450.88, "90th_percentile": 479.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 460.56, "10th_percentile": 460.56, "90th_percentile": 521.33, "count": "1 through 10" } ] } ] }, { "description": "CO2", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 10.0, "minimum": 10.9475, "maximum": 37.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "XR Chest 4+ Views 71048", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 488.0, "discounted_cash": 141.0, "minimum": 104.84, "maximum": 442.616, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 168.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.04 } ] } ] }, { "description": "Rabies Vaccine, PCEC For Inj", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "50632001001", "type": "NDC" }, { "code": "90675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 317.67, "10th_percentile": 312.03, "90th_percentile": 327.78, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1737.88, "10th_percentile": 1737.88, "90th_percentile": 1737.88, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION ANDOR D&C", "code_information": [ { "code": "768", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 12633.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12633.07 } ] } ] }, { "description": "Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 27.0, "minimum": 27.405, "maximum": 94.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 72.58, "10th_percentile": 72.58, "90th_percentile": 72.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.97, "10th_percentile": 34.97, "90th_percentile": 34.97, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [ { "code": "656", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 37533.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37533.75 } ] } ] }, { "description": "SEIZURES WITHOUT MCC", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10640.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10640.73 } ] } ] }, { "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": 6501.0, "minimum": 6501.05, "maximum": 18717.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18717.36 } ] } ] }, { "description": "Bill Chr Anal Amniotic Fl Culture", "code_information": [ { "code": "88235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 886.0, "discounted_cash": 256.0, "minimum": 256.94, "maximum": 886.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 725.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 886.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 711.21 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 886.0 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "858", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 16420.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16420.87 } ] } ] }, { "description": "Magnesium Sulfate IV Soln 2 GM/50ML (40 MG/ML)", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00338170840", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88312 Dahl-Chase - 88312 - 3302007 - 3302007", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 355.75, "discounted_cash": 103.0, "minimum": 103.1675, "maximum": 355.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.16, "10th_percentile": 47.16, "90th_percentile": 47.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 83.9, "10th_percentile": 83.9, "90th_percentile": 85.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 355.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 262.0, "10th_percentile": 262.0, "90th_percentile": 262.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 262.0, "10th_percentile": 262.0, "90th_percentile": 262.0, "count": "1 through 10" } ] } ] }, { "description": "XR Clavicle Left", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.0, "discounted_cash": 96.0, "minimum": 74.35, "maximum": 302.938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 334.0, "10th_percentile": 315.0, "90th_percentile": 334.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.8, "10th_percentile": 100.8, "90th_percentile": 100.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 302.94, "10th_percentile": 302.94, "90th_percentile": 302.94, "count": "1 through 10" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25555.0, "minimum": 25555.84, "maximum": 64298.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64298.28 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 9387.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9387.56 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC", "code_information": [ { "code": "803", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "GC, Amplified DNA", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.25, "discounted_cash": 34.0, "minimum": 34.2925, "maximum": 118.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 79.83, "10th_percentile": 79.83, "90th_percentile": 79.83, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.57, "10th_percentile": 42.57, "90th_percentile": 42.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 71.03, "10th_percentile": 71.03, "90th_percentile": 75.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 92.94, "10th_percentile": 89.32, "90th_percentile": 92.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 90.82, "10th_percentile": 90.82, "90th_percentile": 90.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.25, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "180" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.25, "10th_percentile": 102.13, "90th_percentile": 107.25, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" } ] } ] }, { "description": "Growth Hormone", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.5, "discounted_cash": 65.0, "minimum": 65.395, "maximum": 204.5285, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 137.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 134.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.54 } ] } ] }, { "description": "Ketorolac Tromethamine Inj 15 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016100", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "OTHER FACTORS INFLUENCING HEALTH STATUS", "code_information": [ { "code": "951", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 12017.0535, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6554.67 } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 32404.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32404.37 } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 7132.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7132.33 } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC", "code_information": [ { "code": "863", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 11764.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11764.22 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 28181.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28181.56 } ] } ] }, { "description": "Lactate Dehydrogenase 1", "code_information": [ { "code": "83625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 53.0, "minimum": 53.65, "maximum": 167.795, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 103.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.57 } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 8150.8671, "maximum": 16755.68, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10541.79, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17706.57, "10th_percentile": 17706.57, "90th_percentile": 17706.57, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16755.68 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 53801.0, "minimum": 53801.76, "maximum": 251700.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 251700.62 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 18910.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18910.7 } ] } ] }, { "description": "XR Toes Min Left 2 Views", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.0, "discounted_cash": 85.0, "minimum": 80.1, "maximum": 268.472, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.32, "10th_percentile": 103.32, "90th_percentile": 103.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.36, "10th_percentile": 89.36, "90th_percentile": 89.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 227.33, "10th_percentile": 227.33, "90th_percentile": 227.33, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.53, "10th_percentile": 100.53, "90th_percentile": 106.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.65, "10th_percentile": 102.65, "90th_percentile": 102.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 232.66, "10th_percentile": 232.66, "90th_percentile": 232.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.56 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 296.0, "10th_percentile": 279.25, "90th_percentile": 296.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 255.79, "10th_percentile": 255.79, "90th_percentile": 255.79, "count": "1 through 10" } ] } ] }, { "description": "ED ECHO EXAM OF ABDOMEN FAC", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 537.5, "discounted_cash": 155.0, "minimum": 155.875, "maximum": 504.7462, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 551.14, "10th_percentile": 551.14, "90th_percentile": 551.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 288.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 504.75 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 176.8, "10th_percentile": 176.8, "90th_percentile": 351.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 507.0, "10th_percentile": 507.0, "90th_percentile": 507.0, "count": "1 through 10" } ] } ] }, { "description": "US Obstetrical Follow-Up", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.0, "discounted_cash": 161.0, "minimum": 161.24, "maximum": 556.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 427.01, "10th_percentile": 427.01, "90th_percentile": 427.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 556.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 556.0, "10th_percentile": 524.5, "90th_percentile": 556.0, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 504.29, "10th_percentile": 504.29, "90th_percentile": 504.29, "count": "1 through 10" } ] } ] }, { "description": "Babesia microti Antibody, IgG by IFA", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.75, "discounted_cash": 32.0, "minimum": 32.6975, "maximum": 112.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 106.25, "10th_percentile": 106.25, "90th_percentile": 106.25, "count": "1 through 10" } ] } ] }, { "description": "NM Meckels Abdomen Scan", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 253.0, "minimum": 253.025, "maximum": 872.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 872.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 872.5 } ] } ] }, { "description": "Developmental Testing Ea Add 30 Min OT", "code_information": [ { "code": "96113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.25, "discounted_cash": 67.0, "minimum": 67.3525, "maximum": 210.6507, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MRI Neck wo Contrast", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1604.75, "discounted_cash": 465.0, "minimum": 465.3775, "maximum": 1604.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1604.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1435.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1604.75, "10th_percentile": 1604.75, "90th_percentile": 1604.75, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 26902.323, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20572.95 } ] } ] }, { "description": "Phenobarbital Level", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 57.0, "minimum": 57.13, "maximum": 178.679, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.42, "10th_percentile": 64.42, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 117.91, "10th_percentile": 117.91, "90th_percentile": 117.91, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.04, "10th_percentile": 63.04, "90th_percentile": 63.04, "count": "1 through 10" } ] } ] }, { "description": "XR Scoliosis 1 View", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 100.0, "minimum": 100.05, "maximum": 312.915, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "987", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 40417.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40417.34 } ] } ] }, { "description": "MRI Protocol created for patient 76017", "code_information": [ { "code": "76017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 725.25, "discounted_cash": 210.0, "minimum": 210.3225, "maximum": 725.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 725.25 } ] } ] }, { "description": "LAMBDA ISH 88364 Bill", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 92.0, "minimum": 92.8, "maximum": 320.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "Fructosamine", "code_information": [ { "code": "82985", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.25, "discounted_cash": 44.0, "minimum": 44.7325, "maximum": 154.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 154.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.07, "10th_percentile": 57.07, "90th_percentile": 57.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.36, "10th_percentile": 49.36, "90th_percentile": 49.36, "count": "1 through 10" } ] } ] }, { "description": "Glucose Semi-Quantitative", "code_information": [ { "code": "81005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 15.0, "minimum": 15.95, "maximum": 49.885, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 17.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12 } ] } ] }, { "description": "CH50-Total Complement", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.25, "discounted_cash": 73.0, "minimum": 73.1525, "maximum": 228.7908, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 164.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.38 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CCMCC", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 33973.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33973.48 } ] } ] }, { "description": "74176 FAC CT ABD PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1932.5, "discounted_cash": 560.0, "minimum": 554.88, "maximum": 1752.7775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1347.46, "10th_percentile": 1135.96, "90th_percentile": 1409.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 631.62, "10th_percentile": 527.67, "90th_percentile": 631.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 693.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 554.88 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 538.85, "10th_percentile": 508.33, "90th_percentile": 608.46, "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": 78.6, "median_amount": 1221.25, "10th_percentile": 1221.25, "90th_percentile": 1221.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 899.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 562.79, "10th_percentile": 497.2, "90th_percentile": 1138.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1553.75, "10th_percentile": 1465.75, "90th_percentile": 1754.5, "count": "62" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.68, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 612.44, "10th_percentile": 612.44, "90th_percentile": 1516.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.2, "10th_percentile": 497.2, "90th_percentile": 561.44, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 561.44, "10th_percentile": 497.2, "90th_percentile": 562.79, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.68, "10th_percentile": 469.04, "90th_percentile": 561.44, "count": "1 through 10" } ] } ] }, { "description": "Free Kappa Light Chains, Urine", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.75, "discounted_cash": 39.0, "minimum": 39.3675, "maximum": 126.0788, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.61, "10th_percentile": 103.61, "90th_percentile": 220.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.82, "10th_percentile": 42.19, "90th_percentile": 298.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 298.75, "10th_percentile": 298.75, "90th_percentile": 298.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 110.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 110.54, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 191.2, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.6, "10th_percentile": 95.6, "90th_percentile": 95.6, "count": "1 through 10" } ] } ] }, { "description": "75736 FAC PELVIC ANGIOGM SELECTIVE", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6562.75, "discounted_cash": 1903.0, "minimum": 781.0556, "maximum": 5952.4142, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 924.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1133.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 906.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 781.06 } ] } ] }, { "description": "PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "667", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 13040.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13040.97 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "909", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 15475.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15475.39 } ] } ] }, { "description": "CT Facial Bones w Contrast", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1582.75, "discounted_cash": 458.0, "minimum": 458.9975, "maximum": 1435.5542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.79, "10th_percentile": 569.79, "90th_percentile": 569.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1351.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1081.12 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 874.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1582.75, "10th_percentile": 1582.75, "90th_percentile": 1582.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 506.48, "10th_percentile": 506.48, "90th_percentile": 506.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 409.76, "10th_percentile": 409.76, "90th_percentile": 409.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 506.48, "10th_percentile": 506.48, "90th_percentile": 506.48, "count": "1 through 10" } ] } ] }, { "description": "Leptospira Antibody, IgM by Dot Blot", "code_information": [ { "code": "86720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.25, "discounted_cash": 71.0, "minimum": 70.32, "maximum": 224.2558, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 70.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.18 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 64492.0245, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27386.98 } ] } ] }, { "description": "MRI Cardiac wo 75557", "code_information": [ { "code": "75557", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 782.5, "discounted_cash": 226.0, "minimum": 226.925, "maximum": 782.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 782.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 782.5 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "988", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 19376.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19376.37 } ] } ] }, { "description": "Chlamydia trachomatis NAT", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 25.0, "minimum": 25.8825, "maximum": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 60.32, "10th_percentile": 60.32, "90th_percentile": 60.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.13, "10th_percentile": 32.13, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 56.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 70.15, "10th_percentile": 67.49, "90th_percentile": 70.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 68.54, "10th_percentile": 68.54, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 89.25, "10th_percentile": 84.25, "90th_percentile": 89.25, "count": "180" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 26.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.95, "10th_percentile": 77.17, "90th_percentile": 80.95, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 13334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13334.52 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "958", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 49677.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49677.58 } ] } ] }, { "description": ".C .burnetti IgM Phase I Titer", "code_information": [ { "code": "86638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.25, "discounted_cash": 85.0, "minimum": 85.0425, "maximum": 265.9778, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 98.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.36 } ] } ] }, { "description": "MA Galactogram Multi Duct Right Digital", "code_information": [ { "code": "77054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 577.75, "discounted_cash": 167.0, "minimum": 167.5475, "maximum": 524.0193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 325.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 398.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 318.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.86 } ] } ] }, { "description": "CT Guided Soft Tissue Drain Percu", "code_information": [ { "code": "10030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "discounted_cash": 183.0, "minimum": 183.28, "maximum": 632.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 632.0 } ] } ] }, { "description": "OSTEOMYELITIS WITH MCC", "code_information": [ { "code": "539", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 37657.413, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 14524.24, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7554.62, "10th_percentile": 7554.62, "90th_percentile": 7554.62, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23220.75 } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641612525", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" } ] } ] }, { "description": "Blood product/irradiation", "code_information": [ { "code": "86945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.75, "discounted_cash": 39.0, "minimum": 39.9475, "maximum": 137.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.75 } ] } ] }, { "description": "Lipoprotein (a)", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 59.0, "minimum": 59.16, "maximum": 195.5148, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 125.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.04, "10th_percentile": 85.04, "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": 78.6, "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 160.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 133.5, "10th_percentile": 133.5, "90th_percentile": 242.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 42.72, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 42.72, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 69.36, "count": "1 through 10" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 56124.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56124.98 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 8147.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8147.36 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19951.0, "minimum": 19951.49, "maximum": 58796.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58796.36 } ] } ] }, { "description": "Organic Acids, Urine", "code_information": [ { "code": "83918", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.25, "discounted_cash": 129.0, "minimum": 129.1225, "maximum": 403.8417, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.78 } ] } ] }, { "description": "Chemo IV Each Addl Suquential 0 - 1 Hr", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.25, "discounted_cash": 105.0, "minimum": 105.0525, "maximum": 328.5607, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 231.98, "10th_percentile": 231.98, "90th_percentile": 675.54, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 362.25, "10th_percentile": 362.25, "90th_percentile": 362.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 345.0, "10th_percentile": 345.0, "90th_percentile": 690.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 127.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 234.6, "10th_percentile": 234.6, "90th_percentile": 234.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 117.3, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL Incu w Inhib per Aliq", "code_information": [ { "code": "86977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.5, "discounted_cash": 42.0, "minimum": 42.195, "maximum": 145.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.5 } ] } ] }, { "description": "KAPPA ISH 88365 Bill", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 92.0, "minimum": 92.8, "maximum": 320.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "CT Neck wo Contrast", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1304.75, "discounted_cash": 378.0, "minimum": 378.3775, "maximum": 1183.4082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 443.16, "10th_percentile": 443.16, "90th_percentile": 443.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "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": 792.32 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 10190.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10190.39 } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "869", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8602.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8602.42 } ] } ] }, { "description": "NM Brain Imaging Limited Static", "code_information": [ { "code": "78600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 406.0, "minimum": 406.5075, "maximum": 1271.3872, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 584.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1252.0 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26900.0, "minimum": 26900.88, "maximum": 77234.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77234.32 } ] } ] }, { "description": "Plasma Hemoglobin", "code_information": [ { "code": "83051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.25, "discounted_cash": 98.0, "minimum": 59.13, "maximum": 308.6067, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.91 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 59.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.77 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 38805.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38805.79 } ] } ] }, { "description": "XR Finger-s Min 2 Views", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.75, "discounted_cash": 91.0, "minimum": 84.38, "maximum": 285.4783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 212.65, "10th_percentile": 212.65, "90th_percentile": 212.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.92, "10th_percentile": 106.92, "90th_percentile": 113.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 267.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.01, "10th_percentile": 44.01, "90th_percentile": 314.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 230.18, "10th_percentile": 230.18, "90th_percentile": 230.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 314.75, "10th_percentile": 297.0, "90th_percentile": 314.75, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 100.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.05, "10th_percentile": 100.72, "90th_percentile": 285.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 95.04, "90th_percentile": 100.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.72, "10th_percentile": 100.72, "90th_percentile": 100.98, "count": "1 through 10" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 41925.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41925.15 } ] } ] }, { "description": "US Obstetrical Multi 14- Wk", "code_information": [ { "code": "76802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 331.5, "discounted_cash": 96.0, "minimum": 96.135, "maximum": 300.6705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 130.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22865.0, "minimum": 22865.75, "maximum": 56637.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56637.8 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 34672.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34672.57 } ] } ] }, { "description": "Blastomyces Antibody by ID", "code_information": [ { "code": "86612", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 53.0, "minimum": 53.65, "maximum": 167.795, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 } ] } ] }, { "description": "I-D VULVA ABSCESS FAC", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 357.75, "discounted_cash": 103.0, "minimum": 103.7475, "maximum": 324.4792, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 357.75, "10th_percentile": 357.75, "90th_percentile": 357.75, "count": "1 through 10" } ] } ] }, { "description": "Lead, Blood", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.75, "discounted_cash": 35.0, "minimum": 35.0175, "maximum": 120.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.75, "10th_percentile": 106.0, "90th_percentile": 120.75, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 96.14, "10th_percentile": 96.14, "90th_percentile": 109.52, "count": "1 through 10" } ] } ] }, { "description": "Acetylcholine Receptor Binding Ab", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.75, "discounted_cash": 157.0, "minimum": 109.34, "maximum": 492.2742, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 109.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.58 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 182.0, "10th_percentile": 182.0, "90th_percentile": 182.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.68, "10th_percentile": 49.77, "90th_percentile": 58.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.24, "10th_percentile": 58.24, "90th_percentile": 58.24, "count": "1 through 10" } ] } ] }, { "description": "Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 299.0, "discounted_cash": 86.0, "minimum": 86.71, "maximum": 271.193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 190.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 152.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.69, "10th_percentile": 103.69, "90th_percentile": 103.69, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 174.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.68, "10th_percentile": 95.68, "90th_percentile": 95.68, "count": "1 through 10" } ] } ] }, { "description": "ROM Measurement Hand OT", "code_information": [ { "code": "95852", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.5, "discounted_cash": 16.0, "minimum": 16.675, "maximum": 57.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.5 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "828", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 20086.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20086.06 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18382.0, "minimum": 18382.27, "maximum": 64399.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64399.66 } ] } ] }, { "description": "Methylphenidate and Metabolite, Urine", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.25, "discounted_cash": 88.0, "minimum": 88.2325, "maximum": 275.9547, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 282.25, "10th_percentile": 221.5, "90th_percentile": 299.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 85.43, "10th_percentile": 50.64, "90th_percentile": 140.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.2, "10th_percentile": 211.2, "90th_percentile": 211.2, "count": "1 through 10" } ] } ] }, { "description": "TESTES PROCEDURES WITH CCMCC", "code_information": [ { "code": "711", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 24565.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24565.88 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "754", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21711.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21711.76 } ] } ] }, { "description": "Hepatitis C RNA Qualitative PCR", "code_information": [ { "code": "87521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 113.0, "minimum": 113.97, "maximum": 356.451, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 250 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615104", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [ { "code": "914", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 10439.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10439.14 } ] } ] }, { "description": "MA Breast Diag Tomo Right 77065 77061", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.5, "discounted_cash": 116.0, "minimum": 116.435, "maximum": 401.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 265.82, "10th_percentile": 265.82, "90th_percentile": 265.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.65, "10th_percentile": 133.65, "90th_percentile": 133.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 384.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.75, "10th_percentile": 128.75, "90th_percentile": 128.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 291.8, "10th_percentile": 291.8, "90th_percentile": 297.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.23, "10th_percentile": 4.14, "90th_percentile": 275.52, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 285.12, "10th_percentile": 285.12, "90th_percentile": 285.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.89, "10th_percentile": 81.19, "90th_percentile": 81.89, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 118.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 118.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 118.8, "count": "1 through 10" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [ { "code": "776", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 7718.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7718.25 } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 1 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614800", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "MRSA DNA", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 51.0, "minimum": 51.33, "maximum": 177.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 177.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.0 } ] } ] }, { "description": "XR Hand Left 3 Views", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.75, "discounted_cash": 119.0, "minimum": 85.8, "maximum": 372.5503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 277.45, "10th_percentile": 277.45, "90th_percentile": 277.45, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.87, "10th_percentile": 139.5, "90th_percentile": 147.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.8 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.45, "10th_percentile": 142.45, "90th_percentile": 142.45, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 261.65, "10th_percentile": 261.65, "90th_percentile": 329.01, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 310.43, "10th_percentile": 310.43, "90th_percentile": 310.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.75, "10th_percentile": 131.44, "90th_percentile": 387.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 176.79, "10th_percentile": 176.79, "90th_percentile": 176.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 410.75, "10th_percentile": 387.5, "90th_percentile": 410.75, "count": "92" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 131.44, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 354.95, "10th_percentile": 124.0, "90th_percentile": 372.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 280.51, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 124.0, "90th_percentile": 263.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 131.44, "90th_percentile": 131.75, "count": "1 through 10" } ] } ] }, { "description": "Histoplasma Ag, Urine", "code_information": [ { "code": "87385", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 48.0, "minimum": 48.2125, "maximum": 150.7887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 156.75, "10th_percentile": 156.75, "90th_percentile": 156.75, "count": "1 through 10" } ] } ] }, { "description": "CK (Creatine Kinase)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.5, "discounted_cash": 39.0, "minimum": 39.005, "maximum": 121.9915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 96.3, "10th_percentile": 96.3, "90th_percentile": 96.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.42, "10th_percentile": 48.42, "90th_percentile": 48.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 52.7 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 110.29, "10th_percentile": 110.29, "90th_percentile": 110.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.5, "10th_percentile": 109.06, "90th_percentile": 134.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 134.5, "10th_percentile": 134.5, "90th_percentile": 134.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 121.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 49.77, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 43.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.04, "10th_percentile": 43.04, "90th_percentile": 45.73, "count": "1 through 10" } ] } ] }, { "description": "Drug Monitoring, Phosphatatidylethanol (Peth), Blood - 80321 - 3351254", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.5, "discounted_cash": 110.0, "minimum": 110.925, "maximum": 346.9275, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.4, "10th_percentile": 122.4, "90th_percentile": 122.4, "count": "1 through 10" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "464", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 74580.633, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 12884.41, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 82867.37, "10th_percentile": 82867.37, "90th_percentile": 82867.37, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36719.14 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CCMCC", "code_information": [ { "code": "717", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "$ AP 88346 Kidney Immunofluorescence, 1st", "code_information": [ { "code": "88346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.0, "discounted_cash": 37.0, "minimum": 37.7, "maximum": 130.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.0 } ] } ] }, { "description": "Hepatitis B Core Antibody, Total", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 33.0, "minimum": 33.4225, "maximum": 115.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 88.51, "10th_percentile": 88.51, "90th_percentile": 88.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.72, "10th_percentile": 37.72, "90th_percentile": 37.72, "count": "1 through 10" }, { "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": 78.6, "median_amount": 90.59, "10th_percentile": 90.59, "90th_percentile": 90.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 84.28, "10th_percentile": 84.28, "90th_percentile": 88.51, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 115.25, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.62, "10th_percentile": 99.62, "90th_percentile": 104.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 34.8, "90th_percentile": 36.98, "count": "1 through 10" } ] } ] }, { "description": "XR Scapula Left", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 332.5, "discounted_cash": 96.0, "minimum": 75.77, "maximum": 301.5775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 332.5, "10th_percentile": 332.5, "90th_percentile": 332.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.68, "10th_percentile": 106.68, "90th_percentile": 106.68, "count": "1 through 10" } ] } ] }, { "description": "NM Lymphoseek Up To 0.5MCI", "code_information": [ { "code": "A9520", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2047.5, "minimum": 593.775, "maximum": 2047.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2047.5 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 28983.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28983.21 } ] } ] }, { "description": "MRI Brain w Contrast", "code_information": [ { "code": "70552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1801.5, "discounted_cash": 522.0, "minimum": 522.435, "maximum": 1801.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1801.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.73 } ] } ] }, { "description": "XR Lumbar Sp Min 4-5V", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 703.5, "discounted_cash": 204.0, "minimum": 150.16, "maximum": 638.0745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 238.95, "10th_percentile": 238.95, "90th_percentile": 238.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 150.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 663.75, "10th_percentile": 663.75, "90th_percentile": 703.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 225.12, "10th_percentile": 212.4, "90th_percentile": 225.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 225.12, "10th_percentile": 225.12, "90th_percentile": 225.12, "count": "1 through 10" } ] } ] }, { "description": "MRI Cervical Spine wo Contrast", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.5, "discounted_cash": 558.0, "minimum": 558.395, "maximum": 1746.4285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1478.78, "10th_percentile": 1478.78, "90th_percentile": 1478.78, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 693.18, "10th_percentile": 693.18, "90th_percentile": 693.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 667.76, "10th_percentile": 667.76, "90th_percentile": 667.76, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1542.52, "10th_percentile": 1542.52, "90th_percentile": 1542.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1071.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1925.5, "10th_percentile": 1925.5, "90th_percentile": 1925.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 1746.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 616.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 654.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 616.16, "10th_percentile": 616.16, "90th_percentile": 654.67, "count": "1 through 10" } ] } ] }, { "description": "Chromogranin A", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.75, "discounted_cash": 51.0, "minimum": 51.2575, "maximum": 176.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 176.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.56, "10th_percentile": 56.56, "90th_percentile": 56.7, "count": "1 through 10" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITH CC", "code_information": [ { "code": "386", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 4468.6282, "maximum": 11509.58, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8705.41, "10th_percentile": 8705.41, "90th_percentile": 8705.41, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11509.58 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18135.1995, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4912.78, "10th_percentile": 4912.78, "90th_percentile": 4912.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8116.68, "10th_percentile": 8116.68, "90th_percentile": 19499.2, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15273.8 } ] } ] }, { "description": "Viscosity, Serum", "code_information": [ { "code": "85810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.5, "discounted_cash": 41.0, "minimum": 41.905, "maximum": 131.0615, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.24, "10th_percentile": 46.24, "90th_percentile": 379.58, "count": "1 through 10" } ] } ] }, { "description": "Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 10.0, "minimum": 10.9475, "maximum": 37.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 5", "code_information": [ { "code": "99215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.75, "discounted_cash": 77.0, "minimum": 77.6475, "maximum": 242.8493, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.84, "10th_percentile": 60.84, "90th_percentile": 72.27, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.61, "10th_percentile": 58.61, "90th_percentile": 69.63, "count": "20" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 157.32, "10th_percentile": 57.76, "90th_percentile": 171.5, "count": "66" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.51, "10th_percentile": 118.08, "90th_percentile": 120.51, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 64.24, "count": "87" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 124.22, "10th_percentile": 54.08, "90th_percentile": 216.95, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.22, "10th_percentile": 10.82, "90th_percentile": 178.3, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 57.46, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 64.24, "count": "55" } ] } ] }, { "description": "Cytomegalovirus (CMV) Quant. PCR, Plasma", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 613.25, "discounted_cash": 177.0, "minimum": 177.8425, "maximum": 556.2178, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.24, "10th_percentile": 196.24, "90th_percentile": 196.24, "count": "1 through 10" } ] } ] }, { "description": "IV Infusion Initial up to 1 Hr", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 815.25, "discounted_cash": 236.0, "minimum": 236.4225, "maximum": 739.4317, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 460.93, "10th_percentile": 460.93, "90th_percentile": 583.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 293.49, "10th_percentile": 293.49, "90th_percentile": 293.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 522.09, "10th_percentile": 522.09, "90th_percentile": 522.09, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.73, "10th_percentile": 282.73, "90th_percentile": 282.73, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 651.63, "10th_percentile": 651.63, "90th_percentile": 651.63, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 253.3, "10th_percentile": 124.2, "90th_percentile": 815.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 95.82, "10th_percentile": 95.82, "90th_percentile": 95.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 815.25, "10th_percentile": 815.25, "90th_percentile": 815.25, "count": "144" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 277.19, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 739.43, "10th_percentile": 260.88, "90th_percentile": 746.77, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 301.64, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 277.19, "count": "47" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 260.88, "10th_percentile": 260.88, "90th_percentile": 277.19, "count": "27" } ] } ] }, { "description": "CT Angiography Abdomen w+wo Contrast", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1884.0, "discounted_cash": 546.0, "minimum": 546.36, "maximum": 1884.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 678.24, "10th_percentile": 678.24, "90th_percentile": 678.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 653.37, "10th_percentile": 653.37, "90th_percentile": 653.37, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1884.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 206.72, "10th_percentile": 206.72, "90th_percentile": 206.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1884.0, "10th_percentile": 1777.25, "90th_percentile": 1884.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 657.58, "10th_percentile": 657.58, "90th_percentile": 657.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 602.88, "10th_percentile": 602.88, "90th_percentile": 602.88, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 26828.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26828.18 } ] } ] }, { "description": "75894 FAC TRANSCATH TX EMBOLIZATION", "code_information": [ { "code": "75894", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4059.25, "discounted_cash": 1177.0, "minimum": 1177.1825, "maximum": 4059.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 3644.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4059.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 3572.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4059.25 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 46117.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46117.31 } ] } ] }, { "description": "DNA (ds) AB, Crithidia IFAA w/ Reflx", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.0, "discounted_cash": 41.0, "minimum": 41.76, "maximum": 138.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 117.31, "10th_percentile": 117.31, "90th_percentile": 117.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.84, "10th_percentile": 51.84, "90th_percentile": 51.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 46.08, "count": "1 through 10" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 9704.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9704.69 } ] } ] }, { "description": "36592 COLLECT FROM ES", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.135, "maximum": 28.5705, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 10.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 10.2, "count": "1 through 10" } ] } ] }, { "description": "Vitamin K1 Level", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.25, "discounted_cash": 55.0, "minimum": 55.7525, "maximum": 174.3707, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 147.65, "10th_percentile": 147.65, "90th_percentile": 147.65, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.89 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 154.01, "10th_percentile": 154.01, "90th_percentile": 154.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 192.25, "10th_percentile": 192.25, "90th_percentile": 192.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 61.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 61.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.52, "10th_percentile": 61.52, "90th_percentile": 65.37, "count": "1 through 10" } ] } ] }, { "description": "Glucose, 2 Hour", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.25, "discounted_cash": 19.0, "minimum": 19.7925, "maximum": 61.9027, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.75, "10th_percentile": 4.75, "90th_percentile": 4.75, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 51.7, "10th_percentile": 51.7, "90th_percentile": 51.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.35, "10th_percentile": 68.35, "90th_percentile": 68.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.4 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [ { "code": "657", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 21573.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21573.83 } ] } ] }, { "description": "XR Shoulder Left 1 View", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 101.0, "minimum": 61.5, "maximum": 318.8105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.22 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 64491.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64491.62 } ] } ] }, { "description": "Warfarin Sensitivity CY[2C9 and VKORC1 - 81227 - 3351124 - 3351124", "code_information": [ { "code": "81227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 627.5, "discounted_cash": 181.0, "minimum": 181.975, "maximum": 627.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 547.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 536.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 627.5 } ] } ] }, { "description": "Galactose-Alpha-1,3 Galactose (Alpha -Gal IgE)", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.5, "discounted_cash": 11.0, "minimum": 11.455, "maximum": 39.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 39.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.5 } ] } ] }, { "description": "MA Stereo Clip Spec Tomo Lt 77061 19284", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.5, "discounted_cash": 116.0, "minimum": 116.435, "maximum": 401.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 401.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 401.5 } ] } ] }, { "description": "$ Renal Panel 80069", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.75, "discounted_cash": 50.0, "minimum": 50.3875, "maximum": 157.5913, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 117.42, "10th_percentile": 117.42, "90th_percentile": 117.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.55, "10th_percentile": 59.04, "90th_percentile": 62.55, "count": "30" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 70.27 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.26, "10th_percentile": 56.88, "90th_percentile": 60.26, "count": "24" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 104.47, "10th_percentile": 104.47, "90th_percentile": 104.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 131.38, "10th_percentile": 131.38, "90th_percentile": 131.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.64, "10th_percentile": 27.28, "90th_percentile": 173.75, "count": "21" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 164.0, "10th_percentile": 164.0, "90th_percentile": 173.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 8.68, "90th_percentile": 55.76, "count": "83" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.48, "10th_percentile": 52.48, "90th_percentile": 60.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 60.68, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 52.48, "90th_percentile": 55.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.6, "10th_percentile": 55.6, "90th_percentile": 55.76, "count": "29" } ] } ] }, { "description": "NM Liver Scan w Flow", "code_information": [ { "code": "78202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 516.5, "discounted_cash": 149.0, "minimum": 149.785, "maximum": 516.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 516.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 516.5 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "487", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 18463.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18463.9 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 65110.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65110.54 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 59418.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59418.82 } ] } ] }, { "description": "Gabapentin Level", "code_information": [ { "code": "80171", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.5, "discounted_cash": 161.0, "minimum": 100.25, "maximum": 506.5595, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.89 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 24156.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24156.8 } ] } ] }, { "description": "PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 16193.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16193.34 } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 20071.9192, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 14760.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16937.23 } ] } ] }, { "description": "CT CCTA w+wo Dye Quan Calcium", "code_information": [ { "code": "75574", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 420.0, "minimum": 420.8625, "maximum": 1451.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1333.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1066.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 } ] } ] }, { "description": "XR Scoliosis 4-5 Views 72083", "code_information": [ { "code": "72083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541.75, "discounted_cash": 157.0, "minimum": 157.1075, "maximum": 530.1508, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 530.15 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "606", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 17839.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17839.08 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264786500", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "566", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8833.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8833.48 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 20206.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20206.31 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "833", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 6164.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6164.46 } ] } ] }, { "description": "XR Pelvis 3 Views", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.5, "discounted_cash": 143.0, "minimum": 111.54, "maximum": 447.6045, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.15, "10th_percentile": 171.15, "90th_percentile": 171.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "93246 F EXT ECG>7D<15D RECORDING", "code_information": [ { "code": "93246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.25, "discounted_cash": 18.0, "minimum": 18.3425, "maximum": 57.3678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.77, "10th_percentile": 22.77, "90th_percentile": 22.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 40.51, "10th_percentile": 40.51, "90th_percentile": 40.51, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 50.66, "10th_percentile": 50.66, "90th_percentile": 50.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 63.25, "10th_percentile": 63.25, "90th_percentile": 63.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 47.3, "10th_percentile": 47.3, "90th_percentile": 47.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.82, "10th_percentile": 47.82, "90th_percentile": 47.82, "count": "1 through 10" } ] } ] }, { "description": "SPINAL PROCEDURES WITH MCC", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21296.0, "minimum": 21296.53, "maximum": 70831.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70831.73 } ] } ] }, { "description": "XR Arthrogram Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 409.75, "discounted_cash": 118.0, "minimum": 118.8275, "maximum": 409.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 274.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 336.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 268.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 409.75 } ] } ] }, { "description": "$ AP 88314 Histochemical Stain", "code_information": [ { "code": "88314", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 50.0, "minimum": 50.75, "maximum": 175.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.0 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [ { "code": "626", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17676.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17676.4 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7936.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7936.34 } ] } ] }, { "description": "IR Pulmonary Unilateral Selective", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1338.25, "discounted_cash": 388.0, "minimum": 388.0925, "maximum": 1213.7928, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 829.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.76 } ] } ] }, { "description": "Vaginal Screen, Gard. vaginalis", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 18.0, "minimum": 18.995, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 21266.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21266.14 } ] } ] }, { "description": "Amnisure", "code_information": [ { "code": "84112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.25, "discounted_cash": 56.0, "minimum": 56.3325, "maximum": 194.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "1 through 10" } ] } ] }, { "description": "Gram Stain", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.5, "discounted_cash": 20.0, "minimum": 20.155, "maximum": 63.0365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 52.42, "10th_percentile": 52.42, "90th_percentile": 52.42, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.57, "10th_percentile": 23.22, "90th_percentile": 24.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.67, "10th_percentile": 22.37, "90th_percentile": 47.34, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 52.89, "10th_percentile": 52.89, "90th_percentile": 52.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.67, "10th_percentile": 51.67, "90th_percentile": 51.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.5, "10th_percentile": 45.35, "90th_percentile": 68.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 15.86, "10th_percentile": 15.86, "90th_percentile": 122.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 68.25, "10th_percentile": 64.5, "90th_percentile": 68.25, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 4.27, "90th_percentile": 43.68, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 61.9, "10th_percentile": 21.84, "90th_percentile": 124.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 20.64, "90th_percentile": 65.52, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 4.27, "90th_percentile": 65.79, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.84, "10th_percentile": 21.84, "90th_percentile": 21.84, "count": "1 through 10" } ] } ] }, { "description": "AVULS NAIL PLT SIMP 1 FAC", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 85.0, "minimum": 85.405, "maximum": 267.1115, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.24, "10th_percentile": 94.24, "90th_percentile": 94.24, "count": "1 through 10" } ] } ] }, { "description": "CHG GASTROSTOMY TUBE FAC", "code_information": [ { "code": "31502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 655.0, "discounted_cash": 189.0, "minimum": 189.95, "maximum": 594.085, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 199.6, "10th_percentile": 199.6, "90th_percentile": 199.6, "count": "1 through 10" } ] } ] }, { "description": "CT Heart w+wo Dye Funct", "code_information": [ { "code": "75572", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 420.0, "minimum": 420.8625, "maximum": 1316.2838, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 881.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 705.03 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1288.67 } ] } ] }, { "description": "$ Cannabinoid Confirmation", "code_information": [ { "code": "80349", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 99.0, "minimum": 99.6875, "maximum": 311.7813, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.41 } ] } ] }, { "description": "XR Sella Turcica", "code_information": [ { "code": "70240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.25, "discounted_cash": 122.0, "minimum": 75.77, "maximum": 382.0738, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "Ondansetron HCl Inj 4 MG/2ML (2 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "60505613000", "type": "NDC" }, { "code": "J2405", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "Midazolam HCl Oral/Rectal/Inj 5 MG/5ML (Base Equivalent)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00641605910", "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": 76.8, "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 126.67, "count": "1 through 10" } ] } ] }, { "description": "XR Nasal Bones 3 Views", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.25, "discounted_cash": 113.0, "minimum": 90.09, "maximum": 353.9567, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 90.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 390.25, "10th_percentile": 390.25, "90th_percentile": 390.25, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 8488.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8488.07 } ] } ] }, { "description": "Maternal Serum Screen Integrated Specimen 2", "code_information": [ { "code": "81511", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.25, "discounted_cash": 113.0, "minimum": 113.7525, "maximum": 392.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 392.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.25 } ] } ] }, { "description": "XR Sacroiliac Joints Min 3 Views", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.0, "discounted_cash": 127.0, "minimum": 98.69, "maximum": 398.173, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 98.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 242.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 414.25, "10th_percentile": 414.25, "90th_percentile": 439.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.48, "10th_percentile": 140.48, "90th_percentile": 140.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 398.17, "10th_percentile": 398.17, "90th_percentile": 398.17, "count": "1 through 10" } ] } ] }, { "description": "Antinuclear Antibody Screen", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 44.0, "minimum": 44.2975, "maximum": 138.5443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 103.1, "10th_percentile": 103.1, "90th_percentile": 103.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.94, "10th_percentile": 49.94, "90th_percentile": 52.98, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 91.73, "10th_percentile": 91.73, "90th_percentile": 91.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.36, "10th_percentile": 115.36, "90th_percentile": 120.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.08 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 111.6, "10th_percentile": 111.6, "90th_percentile": 111.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 152.75, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 46.08, "10th_percentile": 46.08, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 46.08, "90th_percentile": 48.88, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.96, "count": "1 through 10" } ] } ] }, { "description": ".Myelin Assoc Glycoprotein IgM Ab By Wb", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.75, "discounted_cash": 139.0, "minimum": 139.7075, "maximum": 436.9472, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.79 } ] } ] }, { "description": "XR Cervical Spine AP+Lat", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466.5, "discounted_cash": 135.0, "minimum": 100.12, "maximum": 423.1155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 315.04, "10th_percentile": 315.04, "90th_percentile": 315.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.6, "10th_percentile": 149.6, "90th_percentile": 149.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 466.5, "10th_percentile": 440.0, "90th_percentile": 466.5, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.28, "10th_percentile": 140.8, "90th_percentile": 149.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.28, "10th_percentile": 149.28, "90th_percentile": 149.28, "count": "1 through 10" } ] } ] }, { "description": "T-Cell Receptor TCRB Gene Rearrangement, PCR - 81340 - 3351273 - 3351273", "code_information": [ { "code": "81340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 820.0, "discounted_cash": 237.0, "minimum": 237.8, "maximum": 820.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 820.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 820.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 820.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.0 } ] } ] }, { "description": "NM Monoclonal Antibody Therapy", "code_information": [ { "code": "79403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3022.25, "discounted_cash": 876.0, "minimum": 407.57, "maximum": 2741.1807, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 415.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 509.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 407.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 854.4 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 45631.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45631.6 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES WITH CCMCC", "code_information": [ { "code": "707", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 23581.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23581.5 } ] } ] }, { "description": "Potassium Chloride Inj 20 mEq/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00990707714", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "Quantiferon TB Gold, 1 Tube", "code_information": [ { "code": "86480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.25, "discounted_cash": 92.0, "minimum": 92.5825, "maximum": 319.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 215.7, "10th_percentile": 215.7, "90th_percentile": 215.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.45, "10th_percentile": 108.45, "90th_percentile": 114.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.72, "10th_percentile": 110.72, "90th_percentile": 110.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 319.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.4, "10th_percentile": 80.4, "90th_percentile": 80.4, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 233.47, "10th_percentile": 233.47, "90th_percentile": 233.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 319.25, "10th_percentile": 301.25, "90th_percentile": 319.25, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 275.95, "10th_percentile": 111.46, "90th_percentile": 289.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.16, "10th_percentile": 102.16, "90th_percentile": 102.16, "count": "1 through 10" } ] } ] }, { "description": "Selenium, Blood Level", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 80.0, "minimum": 80.475, "maximum": 258.17, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.17 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 206.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.68 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 277.5, "10th_percentile": 277.5, "90th_percentile": 277.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.8, "10th_percentile": 88.8, "90th_percentile": 88.8, "count": "1 through 10" } ] } ] }, { "description": "NM CR Phosphate P32 per MCI", "code_information": [ { "code": "A9564", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.25, "minimum": 1.0, "maximum": 285.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 285.25 } ] } ] }, { "description": "U Porphobilinogens, Random - 84110 - 3358879 - 3358879", "code_information": [ { "code": "84110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 365.0, "discounted_cash": 105.0, "minimum": 56.47, "maximum": 331.055, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 56.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.24 } ] } ] }, { "description": "NERVOUS SYSTEM NEOPLASMS WITH MCC", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 18000.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18000.59 } ] } ] }, { "description": "Aph RBC ACDA AS1 LR", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.75, "minimum": 230.4775, "maximum": 720.8383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 286.11, "10th_percentile": 286.11, "90th_percentile": 572.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 508.96, "10th_percentile": 508.96, "90th_percentile": 508.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 275.62, "10th_percentile": 275.62, "90th_percentile": 551.24, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 651.7, "10th_percentile": 651.7, "90th_percentile": 651.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1589.5, "10th_percentile": 794.75, "90th_percentile": 2384.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 508.64, "10th_percentile": 508.64, "90th_percentile": 762.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 254.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 270.22, "10th_percentile": 254.32, "90th_percentile": 508.64, "count": "1 through 10" } ] } ] }, { "description": "Levetiracetam (Keppra) Level", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.5, "discounted_cash": 61.0, "minimum": 61.625, "maximum": 192.7375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.5, "10th_percentile": 72.18, "90th_percentile": 76.5, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.7, "10th_percentile": 73.7, "90th_percentile": 73.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.88, "10th_percentile": 158.88, "90th_percentile": 158.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.0, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 68.0, "count": "1 through 10" } ] } ] }, { "description": "Toxoplasmosis Ab, IgG", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 32.0, "minimum": 32.19, "maximum": 111.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 66.73, "10th_percentile": 66.73, "90th_percentile": 66.73, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.0 } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "624", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 14758.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14758.62 } ] } ] }, { "description": "Echo Doppler Color Flow", "code_information": [ { "code": "93325", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.5, "discounted_cash": 154.0, "minimum": 154.425, "maximum": 482.9775, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 412.69, "10th_percentile": 412.69, "90th_percentile": 412.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 341.01, "10th_percentile": 341.01, "90th_percentile": 347.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.67, "10th_percentile": 184.67, "90th_percentile": 184.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 425.63, "10th_percentile": 425.63, "90th_percentile": 425.63, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 532.5, "10th_percentile": 532.5, "90th_percentile": 532.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 181.05, "10th_percentile": 170.4, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.4, "10th_percentile": 34.08, "90th_percentile": 726.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 24465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24465.67 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 10263.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10263.49 } ] } ] }, { "description": "Inhibin A (Dimer)", "code_information": [ { "code": "86336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.75, "discounted_cash": 68.0, "minimum": 68.3675, "maximum": 213.8253, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 126.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.53 } ] } ] }, { "description": "NM Parathyrd w SPECT + CT", "code_information": [ { "code": "78072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1405.0, "discounted_cash": 407.0, "minimum": 407.45, "maximum": 1405.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1381.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1405.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1354.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1405.0 } ] } ] }, { "description": "$ PTT Heparin Neutralized", "code_information": [ { "code": "85525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.25, "discounted_cash": 44.0, "minimum": 44.4425, "maximum": 138.9977, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 95.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.76 } ] } ] }, { "description": "Famotidine Inj 20 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323073911", "type": "NDC" }, { "code": "J1308", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "20" } ] } ] }, { "description": "Hydromorphone HCl Preservative Free (PF) Inj 10 MG/ML", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323085115", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 25.55, "count": "34" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "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": 196.0, "minimum": 196.91, "maximum": 679.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 679.0 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 32396.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32396.12 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17843.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17843.8 } ] } ] }, { "description": "OT Biofeedback Training addl 15 min", "code_information": [ { "code": "90913", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 24.0, "minimum": 24.215, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "Lactoferrin, Quant, Stool", "code_information": [ { "code": "83631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 490.5, "discounted_cash": 142.0, "minimum": 142.245, "maximum": 444.8835, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 158.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.98 } ] } ] }, { "description": "I-D ABSCESS SIMPLE FAC", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 162.0, "minimum": 162.0375, "maximum": 506.7862, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 193.78, "10th_percentile": 193.78, "90th_percentile": 193.78, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 436.45, "10th_percentile": 436.45, "90th_percentile": 436.45, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 426.39, "10th_percentile": 426.39, "90th_percentile": 439.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 558.75, "10th_percentile": 532.25, "90th_percentile": 558.75, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.32, "10th_percentile": 170.32, "90th_percentile": 178.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 178.8, "10th_percentile": 170.32, "90th_percentile": 178.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 178.8, "10th_percentile": 178.8, "90th_percentile": 180.97, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88319 Group III stains", "code_information": [ { "code": "88319", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 53.0, "minimum": 53.07, "maximum": 183.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.0 } ] } ] }, { "description": "Potassium, Stool", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 21.0, "minimum": 21.8225, "maximum": 68.2518, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2700.0, "10th_percentile": 2700.0, "90th_percentile": 2700.0, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 5367.3981, "maximum": 15357.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15357.5 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 9057.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9057.47 } ] } ] }, { "description": "Mixed Blood Gas", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.25, "discounted_cash": 86.0, "minimum": 86.4925, "maximum": 270.5127, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 241.68 } ] } ] }, { "description": "SKIN ULCERS WITHOUT CCMCC", "code_information": [ { "code": "594", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 10218.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10218.69 } ] } ] }, { "description": "LONG LEG SPLINT FAC", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.25, "discounted_cash": 52.0, "minimum": 52.2725, "maximum": 163.4868, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 171.75, "10th_percentile": 171.75, "90th_percentile": 180.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 157.32, "10th_percentile": 157.32, "90th_percentile": 157.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.4, "10th_percentile": 58.4, "90th_percentile": 58.4, "count": "1 through 10" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITHOUT CCMCC", "code_information": [ { "code": "572", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 13513.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13513.71 } ] } ] }, { "description": "BCR-ABL1 Qualitiative Reflex Quant", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.25, "discounted_cash": 359.0, "minimum": 355.11, "maximum": 1240.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 355.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1240.25 } ] } ] }, { "description": "NM Gastric Emptying", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 256.0, "minimum": 256.215, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 } ] } ] }, { "description": "MA Breast Add Views Tomo BCHP Bilat 77062", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637.5, "discounted_cash": 184.0, "minimum": 184.875, "maximum": 637.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 376.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 637.5 } ] } ] }, { "description": "CT Facial Bones wo Contrast", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1133.75, "discounted_cash": 328.0, "minimum": 328.7875, "maximum": 1028.3112, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 342.24, "90th_percentile": 362.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 993.85, "10th_percentile": 342.24, "90th_percentile": 1028.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 330.8, "90th_percentile": 395.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 351.48, "10th_percentile": 350.64, "90th_percentile": 363.63, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 350.64, "90th_percentile": 362.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 828.86, "10th_percentile": 828.86, "90th_percentile": 828.86, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 385.02, "10th_percentile": 385.02, "90th_percentile": 385.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 358.51, "10th_percentile": 358.51, "90th_percentile": 358.51, "count": "1 through 10" }, { "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": 772.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 350.64, "10th_percentile": 350.64, "90th_percentile": 350.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1095.75, "10th_percentile": 1033.75, "90th_percentile": 1133.75, "count": "16" } ] } ] }, { "description": "Methylmalonic Acid (MMA), Serum", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.25, "discounted_cash": 129.0, "minimum": 129.1225, "maximum": 403.8417, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 445.25, "10th_percentile": 347.86, "90th_percentile": 445.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 103.5, "10th_percentile": 103.5, "90th_percentile": 103.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 445.25, "10th_percentile": 445.25, "90th_percentile": 445.25, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 403.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 142.48, "10th_percentile": 142.48, "90th_percentile": 142.48, "count": "1 through 10" } ] } ] }, { "description": "Coagulation Time, Activated", "code_information": [ { "code": "85347", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.75, "discounted_cash": 13.0, "minimum": 13.5575, "maximum": 43.09, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.09 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.68 } ] } ] }, { "description": "Phenytoin, Free", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.25, "discounted_cash": 14.0, "minimum": 14.8625, "maximum": 51.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 51.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.25 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "923", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11997.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11997.64 } ] } ] }, { "description": "Blood Gas (No Metabolites) Capillary", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.75, "discounted_cash": 99.0, "minimum": 99.3975, "maximum": 342.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 245.41, "10th_percentile": 245.41, "90th_percentile": 245.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.39, "10th_percentile": 123.39, "90th_percentile": 123.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 229.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.87, "10th_percentile": 118.87, "90th_percentile": 118.87, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 281.05, "10th_percentile": 274.54, "90th_percentile": 281.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 342.75, "10th_percentile": 342.75, "90th_percentile": 685.5, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 310.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 109.68, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.68, "10th_percentile": 109.68, "90th_percentile": 116.54, "count": "13" } ] } ] }, { "description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [ { "code": "887", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12624.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12624.82 } ] } ] }, { "description": "INTRO NEEDLE VEIN FAC", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.5, "discounted_cash": 31.0, "minimum": 31.465, "maximum": 98.4095, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.72, "10th_percentile": 34.72, "90th_percentile": 34.72, "count": "1 through 10" } ] } ] }, { "description": "CA 27.29", "code_information": [ { "code": "86300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 35.0, "minimum": 35.8875, "maximum": 123.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 42.03, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.49, "10th_percentile": 40.49, "90th_percentile": 42.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 116.75, "10th_percentile": 116.75, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 37.36, "90th_percentile": 39.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "Tet Tox-Diph-Acell Pertuss Ad Inj 5-2-15.5 LF-LF-MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281040020", "type": "NDC" }, { "code": "90715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 270.57, "10th_percentile": 259.05, "90th_percentile": 273.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.83, "10th_percentile": 120.33, "90th_percentile": 126.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.19, "10th_percentile": 122.19, "90th_percentile": 122.19, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 282.2, "10th_percentile": 282.2, "90th_percentile": 288.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 267.78, "10th_percentile": 267.78, "90th_percentile": 267.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 352.31, "10th_percentile": 0.01, "90th_percentile": 352.31, "count": "64" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 306.18, "10th_percentile": 106.96, "90th_percentile": 322.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 106.96, "90th_percentile": 112.74, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 112.74, "90th_percentile": 113.65, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.74, "10th_percentile": 112.74, "90th_percentile": 113.65, "count": "1 through 10" } ] } ] }, { "description": "Aspartate Aminotransferase", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.5, "discounted_cash": 15.0, "minimum": 15.515, "maximum": 52.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.31, "10th_percentile": 38.31, "90th_percentile": 38.31, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.26, "10th_percentile": 19.26, "90th_percentile": 19.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.55, "10th_percentile": 18.55, "90th_percentile": 18.55, "count": "13" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 42.05, "10th_percentile": 42.05, "90th_percentile": 42.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.76, "10th_percentile": 20.71, "90th_percentile": 53.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 41.46, "10th_percentile": 41.46, "90th_percentile": 41.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 53.5, "10th_percentile": 53.5, "90th_percentile": 53.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 17.12, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 19.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 19.8, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.12, "10th_percentile": 17.12, "90th_percentile": 18.19, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH MCC", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 7952.7074, "maximum": 18035.96, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 9415.31, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4920.0, "10th_percentile": 4920.0, "90th_percentile": 4920.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18035.96 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7651.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7651.05 } ] } ] }, { "description": "I-D ABSCESS TONSIL FAC", "code_information": [ { "code": "42700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.0, "discounted_cash": 111.0, "minimum": 111.36, "maximum": 348.288, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 365.75, "10th_percentile": 365.75, "90th_percentile": 365.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.88, "10th_percentile": 122.88, "90th_percentile": 122.88, "count": "1 through 10" } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC", "code_information": [ { "code": "556", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 36254.484, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9791.93 } ] } ] }, { "description": "Bill IRL Cold Agg Screen", "code_information": [ { "code": "86156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 45.0, "minimum": 45.095, "maximum": 141.0385, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.49 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 51.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.81 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CCMCC", "code_information": [ { "code": "458", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 49190.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49190.7 } ] } ] }, { "description": "ORBITAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 15950.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15950.49 } ] } ] }, { "description": "75605 FAC THORACIC AORTOGRAM", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6666.25, "discounted_cash": 1933.0, "minimum": 578.0235, "maximum": 6046.2887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 876.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1074.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 859.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.02 } ] } ] }, { "description": "CT Simulation Complex", "code_information": [ { "code": "77290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2019.5, "discounted_cash": 585.0, "minimum": 585.655, "maximum": 2019.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1671.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2019.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1638.86 } ] } ] }, { "description": "XR Foot Left AP and Lateral", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.25, "discounted_cash": 79.0, "minimum": 70.06, "maximum": 248.7448, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.58 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 70.06 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 224.89, "10th_percentile": 224.89, "90th_percentile": 224.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.76, "10th_percentile": 87.76, "90th_percentile": 87.76, "count": "1 through 10" } ] } ] }, { "description": "MOUTH PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 10447.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10447.39 } ] } ] }, { "description": "MRI Gadolinium per ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.5, "minimum": 3.625, "maximum": 12.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 126.2, "10th_percentile": 126.2, "90th_percentile": 168.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.45, "10th_percentile": 42.3, "90th_percentile": 90.0, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 5.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.03, "10th_percentile": 43.35, "90th_percentile": 86.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 94.13, "10th_percentile": 94.13, "90th_percentile": 94.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 235.0, "10th_percentile": 117.5, "90th_percentile": 250.0, "count": "29" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.2, "10th_percentile": 40.0, "90th_percentile": 80.0, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 86.95, "10th_percentile": 60.0, "90th_percentile": 226.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.2, "10th_percentile": 56.4, "90th_percentile": 80.0, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.9, "10th_percentile": 59.93, "90th_percentile": 80.0, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.9, "10th_percentile": 60.0, "90th_percentile": 80.0, "count": "12" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40127.0, "minimum": 40127.15, "maximum": 70067.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70067.8 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 19824.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19824.35 } ] } ] }, { "description": "U VMA", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.0, "discounted_cash": 62.0, "minimum": 62.35, "maximum": 195.005, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 125.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.69 } ] } ] }, { "description": "Tacrolimus (FK506) (Prograf)", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.25, "discounted_cash": 70.0, "minimum": 58.96, "maximum": 220.6277, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.57, "10th_percentile": 87.57, "90th_percentile": 87.57, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 84.36, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 191.19, "10th_percentile": 191.19, "90th_percentile": 191.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.08, "10th_percentile": 56.08, "90th_percentile": 56.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.84, "10th_percentile": 73.44, "90th_percentile": 78.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 77.84, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "623", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 21148.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21148.25 } ] } ] }, { "description": "pH Arterial", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 28.0, "minimum": 28.9275, "maximum": 99.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.21, "10th_percentile": 33.21, "90th_percentile": 33.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 68.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 92.25, "10th_percentile": 92.25, "90th_percentile": 92.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.52, "10th_percentile": 29.52, "90th_percentile": 29.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "count": "1 through 10" } ] } ] }, { "description": "SLP Eval of Voice and Resonance Units", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 362.5, "discounted_cash": 105.0, "minimum": 95.0, "maximum": 328.7875, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HC (SUP SHELL C1713) ANCHR/SCREW OPPOS BN-BN/SFT TISS-BN", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 6804.0, "10th_percentile": 6804.0, "90th_percentile": 6804.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1603.23, "10th_percentile": 1603.23, "90th_percentile": 1603.23, "count": "1 through 10" } ] } ] }, { "description": "Chromosome Analysis Amniotic Fluid", "code_information": [ { "code": "88269", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 738.25, "discounted_cash": 214.0, "minimum": 214.0925, "maximum": 738.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 738.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 738.25 } ] } ] }, { "description": "OTHER HEART ASSIST SYSTEM IMPLANT", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 117382.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 117382.87 } ] } ] }, { "description": "74150 FAC CT ABDOMEN W/O CONTRAST", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1737.75, "discounted_cash": 503.0, "minimum": 503.9475, "maximum": 1576.1392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1193.28, "10th_percentile": 1193.28, "90th_percentile": 1193.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 469.04, "10th_percentile": 469.04, "90th_percentile": 498.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1553.75, "10th_percentile": 1465.75, "90th_percentile": 1553.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.2, "10th_percentile": 497.2, "90th_percentile": 497.2, "count": "1 through 10" } ] } ] }, { "description": "NM Y90 Mapping 78201", "code_information": [ { "code": "78201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1364.0, "discounted_cash": 395.0, "minimum": 395.56, "maximum": 1328.1428, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 596.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 731.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 584.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1328.14 } ] } ] }, { "description": "ADH (Copeptin)", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 540.75, "discounted_cash": 156.0, "minimum": 156.8175, "maximum": 490.4602, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 274.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 314.64 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "ANCA, IgG", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 58.0, "minimum": 58.9425, "maximum": 184.3477, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 156.1, "10th_percentile": 156.1, "90th_percentile": 156.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 317.04, "10th_percentile": 317.04, "90th_percentile": 317.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 148.61, "10th_percentile": 148.61, "90th_percentile": 148.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 191.75, "10th_percentile": 150.0, "90th_percentile": 203.25, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.36, "10th_percentile": 19.76, "90th_percentile": 61.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 184.35, "10th_percentile": 65.04, "90th_percentile": 281.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 21.55, "90th_percentile": 175.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 60843.5313, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11094.61 } ] } ] }, { "description": "Thyroid Peroxidase Ab (TPO)", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.75, "discounted_cash": 75.0, "minimum": 75.9075, "maximum": 237.4073, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 176.85, "10th_percentile": 176.85, "90th_percentile": 176.85, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.23, "10th_percentile": 94.23, "90th_percentile": 94.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 117.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.78, "10th_percentile": 90.78, "90th_percentile": 90.78, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 157.34, "10th_percentile": 157.34, "90th_percentile": 157.34, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 197.87, "10th_percentile": 166.03, "90th_percentile": 205.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 261.75, "10th_percentile": 247.0, "90th_percentile": 261.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.76, "10th_percentile": 79.04, "90th_percentile": 83.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 237.41, "10th_percentile": 237.41, "90th_percentile": 237.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.04, "10th_percentile": 79.04, "90th_percentile": 79.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.04, "10th_percentile": 79.04, "90th_percentile": 79.04, "count": "1 through 10" } ] } ] }, { "description": "XR Hip Right 1 View w Pelvis", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.25, "discounted_cash": 101.0, "minimum": 101.5725, "maximum": 317.6768, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "Morphine Sulfate IV Soln PF 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323045201", "type": "NDC" }, { "code": "J2270", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" } ] } ] }, { "description": "CT Thorax w+wo Contrast", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3145.25, "discounted_cash": 912.0, "minimum": 650.0, "maximum": 2852.7418, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1209.66 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 30097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30097.27 } ] } ] }, { "description": "Venous Draw", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.0, "discounted_cash": 9.0, "minimum": 9.28, "maximum": 29.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 22.91, "10th_percentile": 22.91, "90th_percentile": 22.91, "count": "85" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.52, "10th_percentile": 11.52, "90th_percentile": 11.52, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 16.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 16.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "543" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.38, "10th_percentile": 20.38, "90th_percentile": 20.38, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "654" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 7.44, "10th_percentile": 7.33, "90th_percentile": 24.8, "count": "36" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 32.0, "10th_percentile": 32.0, "90th_percentile": 32.0, "count": "1651" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "1423" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 11.84, "10th_percentile": 10.24, "90th_percentile": 29.31, "count": "348" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 11.84, "count": "908" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "187" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.24, "10th_percentile": 10.24, "90th_percentile": 10.88, "count": "662" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 11555.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8860.6 } ] } ] }, { "description": "XR Ribs Left wo Chest Film", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 123.0, "minimum": 84.38, "maximum": 387.0623, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 426.75, "10th_percentile": 426.75, "90th_percentile": 426.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.85, "10th_percentile": 136.85, "90th_percentile": 136.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC", "code_information": [ { "code": "493", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 29898.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29898.03 } ] } ] }, { "description": "Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.75, "discounted_cash": 25.0, "minimum": 25.7375, "maximum": 80.4963, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.78, "10th_percentile": 30.78, "90th_percentile": 30.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 88.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.4, "10th_percentile": 28.4, "90th_percentile": 28.4, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH CC", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 29755.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29755.39 } ] } ] }, { "description": "CT Angio Upper Ext LT w+wo Contrast", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1681.0, "discounted_cash": 487.0, "minimum": 487.49, "maximum": 1681.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1681.0 } ] } ] }, { "description": "Cytogenomic SNP Microarray", "code_information": [ { "code": "81229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2204.0, "discounted_cash": 639.0, "minimum": 93.76, "maximum": 2204.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2204.0 } ] } ] }, { "description": "Vitamin C Level", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.25, "discounted_cash": 40.0, "minimum": 40.0925, "maximum": 125.3928, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 79.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.69 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 14259.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14259.95 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CCMCC", "code_information": [ { "code": "498", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 35564.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35564.99 } ] } ] }, { "description": "SLP Tx Generating Device Units", "code_information": [ { "code": "92609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 762.75, "discounted_cash": 221.0, "minimum": 95.0, "maximum": 691.8143, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Platelet Associated Ab, IgG", "code_information": [ { "code": "86023", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 196.0, "minimum": 100.8, "maximum": 615.6263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.51 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 105940.4895, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 60447.52, "10th_percentile": 60447.52, "90th_percentile": 60447.52, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17981.73 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "963", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 2703.2852, "maximum": 32228.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32228.71 } ] } ] }, { "description": "Alpha-1-Antitrypsin Level", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.5, "discounted_cash": 47.0, "minimum": 47.125, "maximum": 147.3875, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.8, "10th_percentile": 124.8, "90th_percentile": 124.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 108.67 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.73, "10th_percentile": 127.73, "90th_percentile": 130.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 162.5, "10th_percentile": 162.5, "90th_percentile": 162.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.0, "10th_percentile": 52.0, "90th_percentile": 148.85, "count": "1 through 10" } ] } ] }, { "description": "$ RBC, leuko reduced, irr, ea unit", "code_information": [ { "code": "P9040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.75, "minimum": 230.4775, "maximum": 720.8383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 286.11, "10th_percentile": 286.11, "90th_percentile": 286.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 508.96, "10th_percentile": 508.96, "90th_percentile": 508.96, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 275.62, "10th_percentile": 275.62, "90th_percentile": 275.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 270.22, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.32, "10th_percentile": 254.32, "90th_percentile": 254.32, "count": "1 through 10" } ] } ] }, { "description": "Bartonella sp by PCR", "code_information": [ { "code": "87471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1217.25, "discounted_cash": 353.0, "minimum": 210.75, "maximum": 1104.0457, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 } ] } ] }, { "description": "Renin", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.25, "discounted_cash": 74.0, "minimum": 74.8925, "maximum": 234.2328, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 181.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 178.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 258.25, "10th_percentile": 258.25, "90th_percentile": 258.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.64, "10th_percentile": 82.64, "90th_percentile": 82.64, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24608.32 } ] } ] }, { "description": "Antibody Screen (Automated)", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 48.0, "minimum": 48.3575, "maximum": 151.2423, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 56.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 129.23, "10th_percentile": 129.23, "90th_percentile": 129.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.03, "10th_percentile": 60.03, "90th_percentile": 60.03, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 106.79, "10th_percentile": 106.79, "90th_percentile": 106.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.83, "10th_percentile": 57.83, "90th_percentile": 57.83, "count": "13" }, { "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": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 133.28, "10th_percentile": 53.36, "90th_percentile": 151.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 56.7, "count": "1 through 10" } ] } ] }, { "description": "Assistive Tech Assessment/15 min OT", "code_information": [ { "code": "97755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.5, "discounted_cash": 52.0, "minimum": 52.635, "maximum": 164.6205, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Therapeutic Activity/15 min Lymphedema", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.5, "discounted_cash": 48.0, "minimum": 48.575, "maximum": 151.9225, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.6, "10th_percentile": 51.84, "90th_percentile": 103.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.6, "10th_percentile": 53.6, "90th_percentile": 53.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 103.68, "count": "1 through 10" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "739", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 42237.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42237.56 } ] } ] }, { "description": "NM Brain Imaging Vascular Flow Only", "code_information": [ { "code": "78610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 406.0, "minimum": 406.5075, "maximum": 1271.3872, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 770.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 616.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1254.8 } ] } ] }, { "description": "Uric Acid Level, Cold Method", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 18.0, "minimum": 18.705, "maximum": 58.5015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 55.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 27.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.65 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 36.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.97, "10th_percentile": 26.97, "90th_percentile": 26.97, "count": "1 through 10" }, { "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": 49.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 61.11, "10th_percentile": 61.11, "90th_percentile": 62.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.75, "10th_percentile": 53.43, "90th_percentile": 77.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 60.26, "10th_percentile": 60.26, "90th_percentile": 60.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.52, "10th_percentile": 24.88, "90th_percentile": 70.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 13913.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13913.35 } ] } ] }, { "description": "XR Mandible 4 Views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 528.5, "discounted_cash": 153.0, "minimum": 104.4, "maximum": 479.3495, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 } ] } ] }, { "description": "XR Fluoro EGD 74360", "code_information": [ { "code": "74360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1001.0, "discounted_cash": 290.0, "minimum": 290.29, "maximum": 907.907, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 525.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 514.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.38 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CCMCC", "code_information": [ { "code": "749", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 30269.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30269.39 } ] } ] }, { "description": "US Preg Uterus Single", "code_information": [ { "code": "76811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 931.5, "discounted_cash": 270.0, "minimum": 270.135, "maximum": 844.8705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 563.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 450.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 747.25 } ] } ] }, { "description": "REM FB CORNEA WO SLIT FAC", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.0, "discounted_cash": 106.0, "minimum": 106.43, "maximum": 332.869, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 281.86, "10th_percentile": 281.86, "90th_percentile": 281.86, "count": "1 through 10" } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC", "code_information": [ { "code": "511", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 24514.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24514.01 } ] } ] }, { "description": "Adenosine Deaminase, Pleural Fluid", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.0, "discounted_cash": 46.0, "minimum": 46.11, "maximum": 144.213, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 56.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.09 } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 5+ Views 73523", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 543.75, "discounted_cash": 157.0, "minimum": 157.6875, "maximum": 493.1812, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.68, "10th_percentile": 184.68, "90th_percentile": 195.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 348.22, "10th_percentile": 348.22, "90th_percentile": 348.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 354.64, "10th_percentile": 354.64, "90th_percentile": 354.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 543.75, "10th_percentile": 513.0, "90th_percentile": 543.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.0, "10th_percentile": 164.16, "90th_percentile": 174.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 434.62, "10th_percentile": 174.0, "90th_percentile": 493.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.0, "10th_percentile": 164.16, "90th_percentile": 174.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 164.16, "count": "1 through 10" } ] } ] }, { "description": "MA US Elastography EA Add Lesion 76983", "code_information": [ { "code": "76983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 379.25, "discounted_cash": 109.0, "minimum": 109.9825, "maximum": 343.9798, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 } ] } ] }, { "description": "Magnesium Sulfate in Dextrose 5% IV Soln 1 GM/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338170940", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" } ] } ] }, { "description": "XR Chest 2 Views 71046", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 74.0, "minimum": 74.0225, "maximum": 231.5118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.76, "10th_percentile": 182.76, "90th_percentile": 182.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.89, "10th_percentile": 91.89, "90th_percentile": 91.89, "count": "37" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.45 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 122.76 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.53, "10th_percentile": 88.53, "90th_percentile": 88.53, "count": "49" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 209.3, "10th_percentile": 162.59, "90th_percentile": 209.3, "count": "15" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 200.63, "10th_percentile": 200.63, "90th_percentile": 204.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 255.25, "count": "19" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 55.3, "10th_percentile": 55.3, "90th_percentile": 197.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 255.25, "10th_percentile": 255.25, "90th_percentile": 255.25, "count": "360" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "88" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 231.51, "10th_percentile": 231.51, "90th_percentile": 233.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "98" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 86.79, "count": "61" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 86.79, "count": "53" } ] } ] }, { "description": "Smooth Muscle Ab, IgG Titer", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.75, "discounted_cash": 62.0, "minimum": 62.5675, "maximum": 195.6852, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 203.5, "10th_percentile": 203.5, "90th_percentile": 203.5, "count": "1 through 10" } ] } ] }, { "description": "US Transrectal Prost Vol Study", "code_information": [ { "code": "76873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 180.0, "minimum": 180.96, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 395.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 387.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "Prostatic Acid Phosphatase", "code_information": [ { "code": "84066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 62.0, "minimum": 62.7125, "maximum": 196.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 79.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 97.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.55 } ] } ] }, { "description": "88162 AP Bill Non-Gyn Cytology 5+ Slides", "code_information": [ { "code": "88162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.75, "discounted_cash": 56.0, "minimum": 56.7675, "maximum": 195.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.75 } ] } ] }, { "description": "XR Intro LG GI Tube w/Films", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.75, "discounted_cash": 140.0, "minimum": 140.8675, "maximum": 485.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 417.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 485.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 409.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.75 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC", "code_information": [ { "code": "686", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21263.78 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 18913.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18913.06 } ] } ] }, { "description": "Coronary Risk Panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 57.0, "minimum": 57.42, "maximum": 179.586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 133.71, "10th_percentile": 128.34, "90th_percentile": 133.71, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 67.23, "90th_percentile": 71.28, "count": "148" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.56 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 108.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.89, "10th_percentile": 64.77, "90th_percentile": 68.67, "count": "149" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 126.13, "10th_percentile": 121.03, "90th_percentile": 126.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 149.61, "10th_percentile": 143.6, "90th_percentile": 155.63, "count": "83" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.04, "10th_percentile": 29.06, "90th_percentile": 186.75, "count": "95" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 46.02, "10th_percentile": 41.05, "90th_percentile": 145.92, "count": "16" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 13.39, "10th_percentile": 13.39, "90th_percentile": 13.39, "count": "461" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "385" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 149.27, "10th_percentile": 59.76, "90th_percentile": 179.59, "count": "130" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.8, "10th_percentile": 59.76, "90th_percentile": 63.36, "count": "250" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.8, "10th_percentile": 60.8, "90th_percentile": 63.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 59.76, "90th_percentile": 63.5, "count": "172" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH CC", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 25712.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25712.94 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 20515.5635, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15599.36, "10th_percentile": 15599.36, "90th_percentile": 19499.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13816.75, "10th_percentile": 13816.75, "90th_percentile": 13816.75, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9477.16 } ] } ] }, { "description": "Urine Culture", "code_information": [ { "code": "87088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 42.0, "minimum": 42.485, "maximum": 132.8755, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 98.99, "10th_percentile": 98.99, "90th_percentile": 98.99, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.74, "10th_percentile": 49.77, "90th_percentile": 52.74, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.81, "10th_percentile": 47.95, "90th_percentile": 50.81, "count": "58" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 88.07, "90th_percentile": 117.35, "count": "16" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.15, "10th_percentile": 110.75, "90th_percentile": 115.15, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.04, "10th_percentile": 11.02, "90th_percentile": 146.5, "count": "37" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 107.14, "10th_percentile": 34.05, "90th_percentile": 112.51, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.5, "10th_percentile": 138.25, "90th_percentile": 146.5, "count": "301" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.24, "10th_percentile": 8.09, "90th_percentile": 46.88, "count": "204" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 51.15, "10th_percentile": 46.88, "90th_percentile": 132.88, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 51.15, "count": "105" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 47.01, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 44.24, "90th_percentile": 47.01, "count": "58" } ] } ] }, { "description": "SLP Auditory Processing Tx Units", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.25, "discounted_cash": 105.0, "minimum": 95.0, "maximum": 330.3748, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS", "code_information": [ { "code": "870", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28470.0, "minimum": 28470.1, "maximum": 81483.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81483.07 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH CC", "code_information": [ { "code": "975", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 15266.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15266.73 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "696", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 1436.2711, "maximum": 8122.61, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5156.0, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8122.61 } ] } ] }, { "description": "CT Thoracic Spine w Contrast", "code_information": [ { "code": "72129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1840.5, "discounted_cash": 533.0, "minimum": 533.745, "maximum": 1669.3335, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1106.86 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 989.76 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC", "code_information": [ { "code": "565", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 38712.852, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7799.68, "10th_percentile": 7799.68, "90th_percentile": 7799.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 38368.74, "standard_charge_algorithm": "89.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 7799.68, "10th_percentile": 7799.68, "90th_percentile": 7799.68, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11487.18 } ] } ] }, { "description": "Rad Ther Port Film", "code_information": [ { "code": "77417", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.5, "discounted_cash": 62.0, "minimum": 62.495, "maximum": 195.4585, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 64.35 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 41112.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41112.89 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 48775.7039, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 57504.94, "10th_percentile": 57504.94, "90th_percentile": 84290.67, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20703.81 } ] } ] }, { "description": ".LDL Cholesterol, Direct Reflex", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 29.0, "minimum": 29.87, "maximum": 97.3402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 88.61, "10th_percentile": 88.61, "90th_percentile": 88.61, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 44.55, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.2 }, { "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": 65.61, "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": 78.6, "median_amount": 82.51, "10th_percentile": 82.51, "90th_percentile": 97.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.75, "10th_percentile": 103.0, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 38.11, "90th_percentile": 45.79, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.02, "10th_percentile": 35.02, "90th_percentile": 39.6, "count": "1 through 10" } ] } ] }, { "description": "HEADACHES WITHOUT MCC", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 9859.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9859.12 } ] } ] }, { "description": "75756 FAC ARTERY X-RAYS, CHEST", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2507.5, "discounted_cash": 727.0, "minimum": 727.175, "maximum": 2274.3025, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 945.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1158.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 926.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 941.82 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 71471.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71471.87 } ] } ] }, { "description": "PNEUMOTHORAX WITHOUT CCMCC", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 15892.929, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8430.3 } ] } ] }, { "description": "PT Appl Multilay Comprs Arm/Hand Unit", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.0, "discounted_cash": 139.0, "minimum": 95.0, "maximum": 437.174, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Follicle Stimulating Hormone", "code_information": [ { "code": "83001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.75, "discounted_cash": 61.0, "minimum": 61.9875, "maximum": 193.8713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 164.16, "10th_percentile": 164.16, "90th_percentile": 164.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 153.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 150.4 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.16, "10th_percentile": 136.16, "90th_percentile": 136.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 172.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 213.75, "10th_percentile": 213.75, "90th_percentile": 213.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 193.87, "10th_percentile": 193.87, "90th_percentile": 195.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 79.09, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" } ] } ] }, { "description": "Cancer Antigen 125", "code_information": [ { "code": "86304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.5, "discounted_cash": 68.0, "minimum": 68.005, "maximum": 212.6915, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 171.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 210.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 168.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.32, "10th_percentile": 81.32, "90th_percentile": 81.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 234.5, "10th_percentile": 234.5, "90th_percentile": 234.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.04, "10th_percentile": 75.04, "90th_percentile": 75.04, "count": "1 through 10" } ] } ] }, { "description": "XR Chest 1 View 71045", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 74.0, "minimum": 43.68, "maximum": 231.5118, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.76, "10th_percentile": 182.76, "90th_percentile": 182.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.89, "10th_percentile": 91.89, "90th_percentile": 91.89, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 79.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.53, "10th_percentile": 88.53, "90th_percentile": 88.53, "count": "20" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 209.31, "10th_percentile": 204.46, "90th_percentile": 209.31, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 200.63, "10th_percentile": 200.63, "90th_percentile": 204.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.42, "10th_percentile": 161.42, "90th_percentile": 161.42, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 255.25, "10th_percentile": 255.25, "90th_percentile": 255.25, "count": "114" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 86.79, "count": "48" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 231.51, "10th_percentile": 81.68, "90th_percentile": 233.81, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 81.68, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 86.79, "count": "39" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.68, "10th_percentile": 81.68, "90th_percentile": 86.79, "count": "18" } ] } ] }, { "description": "XR ERCP Biliary+Pancreatic", "code_information": [ { "code": "74330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1661.5, "discounted_cash": 481.0, "minimum": 481.835, "maximum": 1506.9805, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 504.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 618.51 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 494.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "Ectoparasite Identification", "code_information": [ { "code": "87168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.5, "discounted_cash": 9.0, "minimum": 9.425, "maximum": 32.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "1 through 10" } ] } ] }, { "description": "IgA (Immunoglobulin A)", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 28.0, "minimum": 28.9275, "maximum": 90.4732, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 87.17, "10th_percentile": 87.17, "90th_percentile": 87.17, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.83, "10th_percentile": 36.54, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 60.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.2, "10th_percentile": 35.2, "90th_percentile": 77.43, "count": "12" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.55, "10th_percentile": 77.55, "90th_percentile": 77.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.08, "10th_percentile": 41.4, "90th_percentile": 101.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 23.59, "10th_percentile": 23.59, "90th_percentile": 23.59, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.75, "10th_percentile": 101.5, "90th_percentile": 345.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.96, "10th_percentile": 32.48, "90th_percentile": 75.91, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 77.92, "10th_percentile": 38.96, "90th_percentile": 110.43, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.44, "10th_percentile": 38.96, "90th_percentile": 90.1, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.44, "10th_percentile": 38.96, "90th_percentile": 110.4, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.96, "10th_percentile": 38.96, "90th_percentile": 71.44, "count": "1 through 10" } ] } ] }, { "description": "CT Temp Bones wo Contrast", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1720.5, "discounted_cash": 498.0, "minimum": 498.945, "maximum": 1560.4935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.47 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1623.0, "10th_percentile": 1623.0, "90th_percentile": 1623.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 550.56, "10th_percentile": 550.56, "90th_percentile": 550.56, "count": "1 through 10" } ] } ] }, { "description": "Oxcarbazepine Metabolite", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 27.0, "minimum": 27.26, "maximum": 94.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.08, "10th_percentile": 30.08, "90th_percentile": 30.08, "count": "1 through 10" } ] } ] }, { "description": "Beta Strep AST-01 Systemic", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.5, "discounted_cash": 36.0, "minimum": 36.395, "maximum": 113.8285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 84.85, "10th_percentile": 84.85, "90th_percentile": 91.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.66, "10th_percentile": 42.66, "90th_percentile": 45.18, "count": "12" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.1, "10th_percentile": 41.1, "90th_percentile": 82.19, "count": "29" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 150.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 93.14, "10th_percentile": 93.14, "90th_percentile": 189.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.16, "10th_percentile": 25.09, "90th_percentile": 118.5, "count": "24" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 29.17, "10th_percentile": 29.17, "90th_percentile": 91.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.5, "10th_percentile": 118.5, "90th_percentile": 125.5, "count": "108" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 8.65, "90th_percentile": 75.84, "count": "100" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.85, "10th_percentile": 37.92, "90th_percentile": 113.83, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 118.5, "count": "44" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.16, "10th_percentile": 37.92, "90th_percentile": 116.0, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.92, "10th_percentile": 37.92, "90th_percentile": 75.84, "count": "27" } ] } ] }, { "description": "ABSCESS DENTAL GUM FAC", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.5, "discounted_cash": 101.0, "minimum": 101.065, "maximum": 316.0895, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 273.92, "10th_percentile": 273.92, "90th_percentile": 273.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 348.5, "10th_percentile": 332.0, "90th_percentile": 348.5, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.52, "10th_percentile": 111.52, "90th_percentile": 111.52, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC", "code_information": [ { "code": "840", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 38136.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38136.17 } ] } ] }, { "description": "NM Adrenal Scan", "code_information": [ { "code": "78075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1201.5, "discounted_cash": 348.0, "minimum": 348.435, "maximum": 1201.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1201.5 } ] } ] }, { "description": ".Cryoglobulin reflex", "code_information": [ { "code": "86329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 27.0, "minimum": 27.26, "maximum": 94.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 } ] } ] }, { "description": "CT Angiography Chest w+wo Contrast", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2105.0, "discounted_cash": 610.0, "minimum": 610.45, "maximum": 1909.235, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1421.8, "10th_percentile": 1421.8, "90th_percentile": 1421.8, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 378.9, "10th_percentile": 357.44, "90th_percentile": 757.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 730.01, "10th_percentile": 688.66, "90th_percentile": 730.01, "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": 78.6, "median_amount": 1654.53, "10th_percentile": 1654.53, "90th_percentile": 1654.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1722.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 443.59, "10th_percentile": 443.59, "90th_percentile": 588.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2105.0, "10th_percentile": 1985.75, "90th_percentile": 2105.0, "count": "40" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 675.16, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 734.73, "10th_percentile": 635.44, "90th_percentile": 1909.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 635.44, "90th_percentile": 673.6, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 673.6, "10th_percentile": 673.6, "90th_percentile": 675.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 675.16, "10th_percentile": 673.6, "90th_percentile": 675.16, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 23838.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23838.5 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10804.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10804.6 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "723", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13471.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13471.27 } ] } ] }, { "description": "Hgb", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.75, "discounted_cash": 10.0, "minimum": 10.6575, "maximum": 33.3323, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 29.54, "10th_percentile": 29.54, "90th_percentile": 29.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.23, "10th_percentile": 12.51, "90th_percentile": 15.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.75, "10th_percentile": 12.06, "90th_percentile": 15.18, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 22.14, "10th_percentile": 22.14, "90th_percentile": 22.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.75, "10th_percentile": 36.75, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 41.25, "10th_percentile": 34.75, "90th_percentile": 43.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 13.2, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 14.0, "10th_percentile": 11.12, "90th_percentile": 39.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 12.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.76, "90th_percentile": 11.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.76, "10th_percentile": 11.12, "90th_percentile": 11.82, "count": "27" } ] } ] }, { "description": "Absolute CD19", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.0, "discounted_cash": 55.0, "minimum": 55.39, "maximum": 191.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 150.13, "10th_percentile": 150.13, "90th_percentile": 150.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.0 } ] } ] }, { "description": "Anaplasma phagocytophilum by RT-PCR", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.5, "discounted_cash": 80.0, "minimum": 80.185, "maximum": 276.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 805.86, "10th_percentile": 619.16, "90th_percentile": 916.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 299.9, "10th_percentile": 165.0, "90th_percentile": 413.82, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 716.94, "10th_percentile": 45.92, "90th_percentile": 716.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 44.86, "10th_percentile": 44.86, "90th_percentile": 797.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 59.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 368.71, "10th_percentile": 368.71, "90th_percentile": 368.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 56.0, "10th_percentile": 56.0, "90th_percentile": 59.25, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 360.16, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.48, "10th_percentile": 18.96, "90th_percentile": 1189.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.96, "10th_percentile": 17.92, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.0, "10th_percentile": 19.04, "90th_percentile": 381.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 381.84, "10th_percentile": 19.04, "90th_percentile": 381.84, "count": "1 through 10" } ] } ] }, { "description": "XR Urethrocystogram Retro S+I 74450", "code_information": [ { "code": "74450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1059.0, "discounted_cash": 307.0, "minimum": 230.25, "maximum": 960.513, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.27 } ] } ] }, { "description": "Lidocaine Level", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.25, "discounted_cash": 31.0, "minimum": 31.9725, "maximum": 110.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.25 } ] } ] }, { "description": "Contrast Baths/15M PT", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.75, "discounted_cash": 30.0, "minimum": 30.0875, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "Echo 2-D Limited F/U w/Contrast - C8924 - 5001003", "code_information": [ { "code": "C8924", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1496.75, "minimum": 434.0575, "maximum": 1357.5522, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 508.9, "10th_percentile": 508.9, "90th_percentile": 508.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 852.89, "10th_percentile": 852.89, "90th_percentile": 852.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 478.96, "10th_percentile": 478.96, "90th_percentile": 478.96, "count": "1 through 10" } ] } ] }, { "description": "NM Inflamation Local Limited 78800", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1573.0, "discounted_cash": 456.0, "minimum": 456.17, "maximum": 1573.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 595.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 729.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 583.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1573.0 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 10835.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10835.25 } ] } ] }, { "description": "Estradiol Lvl", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.5, "discounted_cash": 101.0, "minimum": 101.645, "maximum": 326.61, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 266.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 261.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 299.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.16, "10th_percentile": 112.16, "90th_percentile": 112.16, "count": "1 through 10" } ] } ] }, { "description": "MRI Orbit and or Face w+wo Contrast", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2647.75, "discounted_cash": 767.0, "minimum": 767.8475, "maximum": 2647.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2033.47, "10th_percentile": 2033.47, "90th_percentile": 2033.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2647.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "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": 2097.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2647.75, "10th_percentile": 2647.75, "90th_percentile": 2647.75, "count": "1 through 10" } ] } ] }, { "description": "Lamotrigine (Lamictal) Level", "code_information": [ { "code": "80175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.75, "discounted_cash": 76.0, "minimum": 76.4875, "maximum": 239.2212, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.95, "10th_percentile": 94.95, "90th_percentile": 94.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 168.01, "10th_percentile": 168.01, "90th_percentile": 168.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.4, "10th_percentile": 84.4, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.4, "10th_percentile": 84.4, "90th_percentile": 84.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.58, "10th_percentile": 84.58, "90th_percentile": 84.58, "count": "1 through 10" } ] } ] }, { "description": "NORMAL NEWBORN", "code_information": [ { "code": "795", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 2355.44, "maximum": 7262.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 2355.44 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITHOUT CCMCC", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8443.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8443.27 } ] } ] }, { "description": "Uric Acid, Body Fluid", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 35.0, "minimum": 35.8875, "maximum": 112.2412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 112.24, "10th_percentile": 112.24, "90th_percentile": 112.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.08, "10th_percentile": 5.08, "90th_percentile": 5.08, "count": "1 through 10" } ] } ] }, { "description": "XR Lumbar Spine AP+Lateral", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 564.5, "discounted_cash": 163.0, "minimum": 107.26, "maximum": 512.0015, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 381.27, "10th_percentile": 381.27, "90th_percentile": 433.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 203.22, "10th_percentile": 191.7, "90th_percentile": 203.22, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.67, "10th_percentile": 184.67, "90th_percentile": 195.77, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 359.59, "10th_percentile": 359.59, "90th_percentile": 359.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 181.05, "10th_percentile": 9.76, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 564.5, "10th_percentile": 532.5, "90th_percentile": 564.5, "count": "43" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 512.0, "10th_percentile": 180.64, "90th_percentile": 512.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 181.05, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.64, "10th_percentile": 170.4, "90th_percentile": 180.64, "count": "1 through 10" } ] } ] }, { "description": "Prochlorperazine Edisylate Inj 10 MG/2ML", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "23155029431", "type": "NDC" }, { "code": "J0780", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 32.74, "10th_percentile": 32.74, "90th_percentile": 32.74, "count": "1 through 10" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 13966.3917, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17549.28, "10th_percentile": 17549.28, "90th_percentile": 17549.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 6431.46, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9500.74 } ] } ] }, { "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": 4707.0, "minimum": 4707.65, "maximum": 17742.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17742.41 } ] } ] }, { "description": "IR Ureters or Urethral Dilation 74485", "code_information": [ { "code": "74485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8110.5, "discounted_cash": 2352.0, "minimum": 357.49, "maximum": 7356.2235, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 364.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 446.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 357.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.17 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC", "code_information": [ { "code": "844", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 14351.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14351.9 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 20429.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20429.12 } ] } ] }, { "description": "Specific Gravity, Body Fluid", "code_information": [ { "code": "84315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.1075, "maximum": 37.8672, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.41 } ] } ] }, { "description": "CT Thorax wo Contrast Low Dose 71250", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1968.5, "discounted_cash": 570.0, "minimum": 570.865, "maximum": 1785.4295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1213.26, "10th_percentile": 1213.26, "90th_percentile": 1213.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 646.65, "10th_percentile": 610.02, "90th_percentile": 646.65, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 622.94, "10th_percentile": 587.65, "90th_percentile": 622.94, "count": "1 through 10" }, { "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": 724.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 574.8, "90th_percentile": 576.13, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1796.25, "10th_percentile": 1694.5, "90th_percentile": 1796.25, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 574.8, "10th_percentile": 574.8, "90th_percentile": 1629.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 574.8, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 576.13, "10th_percentile": 574.8, "90th_percentile": 576.13, "count": "51" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.8, "10th_percentile": 542.24, "90th_percentile": 576.13, "count": "18" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "741", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 16812.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16812.26 } ] } ] }, { "description": "Bill IRL Dilut of Serum Ea Alq", "code_information": [ { "code": "86976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.1075, "maximum": 41.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.75 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "393", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 18854.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18854.12 } ] } ] }, { "description": "DRVVT (Patient)", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 27.0, "minimum": 27.26, "maximum": 88.8114, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.6, "10th_percentile": 32.6, "90th_percentile": 32.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 88.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 88.75, "10th_percentile": 88.75, "90th_percentile": 213.25, "count": "1 through 10" } ] } ] }, { "description": "Albumin,Serum", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 10.0, "minimum": 10.5125, "maximum": 36.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.58, "10th_percentile": 12.58, "90th_percentile": 12.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 36.25, "10th_percentile": 36.25, "90th_percentile": 36.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 12.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 13.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.6, "10th_percentile": 11.6, "90th_percentile": 11.6, "count": "1 through 10" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "948", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 26290.1598, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6090.81, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6073.13, "10th_percentile": 3762.12, "90th_percentile": 23529.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11699.52, "10th_percentile": 3899.84, "90th_percentile": 29248.8, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 26056.47, "standard_charge_algorithm": "89.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 5849.76, "10th_percentile": 5849.76, "90th_percentile": 5849.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22397.42, "10th_percentile": 22397.42, "90th_percentile": 79250.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9437.08 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM O.R. PROCEDURES", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15019.0, "minimum": 15019.66, "maximum": 39382.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39382.27 } ] } ] }, { "description": "U/S Guidance Vasc Access HF US", "code_information": [ { "code": "76937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 569.25, "discounted_cash": 165.0, "minimum": 82.95, "maximum": 516.3098, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CCMCC", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 21308.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21308.58 } ] } ] }, { "description": "TX METACARP FX MANI FAC", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.25, "discounted_cash": 93.0, "minimum": 93.7425, "maximum": 293.1877, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 307.75, "10th_percentile": 307.75, "90th_percentile": 307.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "630", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17206.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17206.02 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 15429.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15429.42 } ] } ] }, { "description": "Bill HLA DR Typing", "code_information": [ { "code": "86817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 687.25, "discounted_cash": 199.0, "minimum": 199.3025, "maximum": 687.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 520.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 687.25 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "969", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26228.0, "minimum": 26228.36, "maximum": 72163.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72163.88 } ] } ] }, { "description": "Cyclosporine A", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 78.0, "minimum": 78.155, "maximum": 244.4365, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 146.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.33 } ] } ] }, { "description": "Methadone & Metabolite, Quant. Urine", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 45.0, "minimum": 45.095, "maximum": 141.0385, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.63 } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8193.3226, "maximum": 15495.44, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 9136.22, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11933.43, "10th_percentile": 11933.43, "90th_percentile": 12590.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6167.61, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8742.79, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25714.23, "10th_percentile": 25714.23, "90th_percentile": 25714.23, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15495.44 } ] } ] }, { "description": "$ COVID/FLU Combo", "code_information": [ { "code": "87636", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 454.5, "discounted_cash": 131.0, "minimum": 131.805, "maximum": 454.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 306.99, "10th_percentile": 306.99, "90th_percentile": 306.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.35, "10th_percentile": 154.35, "90th_percentile": 163.62, "count": "22" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 428.75, "10th_percentile": 428.75, "90th_percentile": 454.5, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.7, "10th_percentile": 148.7, "90th_percentile": 157.62, "count": "22" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 171.16, "10th_percentile": 142.63, "90th_percentile": 289.13, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 357.24, "10th_percentile": 343.47, "90th_percentile": 357.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 454.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.78, "10th_percentile": 145.44, "90th_percentile": 428.75, "count": "19" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 332.28, "10th_percentile": 306.99, "90th_percentile": 332.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 99.84, "10th_percentile": 99.84, "90th_percentile": 99.84, "count": "552" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.78, "count": "54" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 392.74, "10th_percentile": 145.44, "90th_percentile": 412.23, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 158.64, "count": "49" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.44, "10th_percentile": 137.2, "90th_percentile": 145.78, "count": "58" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.78, "10th_percentile": 145.44, "90th_percentile": 145.78, "count": "31" } ] } ] }, { "description": "Helicobacter pylori Ab, IgG", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.75, "discounted_cash": 26.0, "minimum": 26.6075, "maximum": 91.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.75 } ] } ] }, { "description": "REM IMPACTED CERUMEN FAC", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.5, "discounted_cash": 79.0, "minimum": 79.605, "maximum": 248.9715, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 261.5, "10th_percentile": 261.5, "90th_percentile": 274.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.84, "10th_percentile": 87.84, "90th_percentile": 87.84, "count": "1 through 10" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 28780.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28780.44 } ] } ] }, { "description": "MOUTH PROCEDURES WITH CCMCC", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 17603.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17603.3 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "661", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 12206.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12206.31 } ] } ] }, { "description": "Meningitis/Encephalitis PCR Panel, CSF", "code_information": [ { "code": "87483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 206.0, "minimum": 206.2625, "maximum": 711.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 214.72, "10th_percentile": 214.72, "90th_percentile": 214.72, "count": "1 through 10" } ] } ] }, { "description": "$ AP 88362 Nerve Tesing Prep", "code_information": [ { "code": "88362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.0, "discounted_cash": 223.0, "minimum": 223.88, "maximum": 772.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.0 } ] } ] }, { "description": "Barbiturate, Urine Quantitative - 80345 - 3350616", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.0, "discounted_cash": 48.0, "minimum": 48.43, "maximum": 151.469, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.05 } ] } ] }, { "description": "88363 Retrieval of Archived Specimens", "code_information": [ { "code": "88363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 35.0, "minimum": 35.235, "maximum": 121.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.5 } ] } ] }, { "description": "$ AP 88348 Kidney Electron Microscopy", "code_information": [ { "code": "88348", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1262.0, "discounted_cash": 365.0, "minimum": 365.98, "maximum": 1262.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1262.0 } ] } ] }, { "description": "Coagulation Workup Mixing Studies", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.25, "discounted_cash": 82.0, "minimum": 82.7225, "maximum": 258.7217, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 95.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.86 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.28, "10th_percentile": 91.28, "90th_percentile": 91.28, "count": "1 through 10" } ] } ] }, { "description": "IsoPSA", "code_information": [ { "code": "0359U", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 812.5, "minimum": 235.625, "maximum": 812.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 812.5 } ] } ] }, { "description": "75625 FAC AORTOGRPHY ABD SERIAL S&I", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8687.25, "discounted_cash": 2519.0, "minimum": 507.5461, "maximum": 7879.3358, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 868.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1063.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 850.87 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.55 } ] } ] }, { "description": "US Infant Hips Limited", "code_information": [ { "code": "76886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.75, "discounted_cash": 118.0, "minimum": 118.5375, "maximum": 408.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.75 } ] } ] }, { "description": "NM Kidney Funct Non-Imaging Study", "code_information": [ { "code": "78725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 708.5, "discounted_cash": 205.0, "minimum": 205.465, "maximum": 676.7737, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 320.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 393.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 314.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.77 } ] } ] }, { "description": "XR Acromid Clavicular Joints Bilateral", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.75, "discounted_cash": 137.0, "minimum": 98.69, "maximum": 431.5052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 98.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 448.75, "10th_percentile": 448.75, "90th_percentile": 448.75, "count": "1 through 10" } ] } ] }, { "description": "ASP INJECT MAJOR JT FAC", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.5, "discounted_cash": 273.0, "minimum": 273.615, "maximum": 855.7545, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 898.5, "10th_percentile": 898.5, "90th_percentile": 898.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 301.92, "10th_percentile": 301.92, "90th_percentile": 301.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 301.92, "10th_percentile": 301.92, "90th_percentile": 301.92, "count": "1 through 10" } ] } ] }, { "description": "Fluphenazine Level", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.75, "discounted_cash": 52.0, "minimum": 52.4175, "maximum": 163.9402, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.79 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8653.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8653.11 } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 13494.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13494.85 } ] } ] }, { "description": "SSA 60 (Ro) (ENA) Antibody, IgG", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 43.0, "minimum": 43.065, "maximum": 148.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 678.91, "10th_percentile": 678.91, "90th_percentile": 678.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 420.0, "10th_percentile": 270.75, "90th_percentile": 693.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 274.96, "90th_percentile": 274.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.76, "10th_percentile": 173.76, "90th_percentile": 173.76, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 45908.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45908.65 } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC", "code_information": [ { "code": "872", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 6736.1338, "maximum": 12063.66, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13649.44, "10th_percentile": 13649.44, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10279.35, "10th_percentile": 10279.35, "90th_percentile": 10279.35, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8721.12, "10th_percentile": 8721.12, "90th_percentile": 8721.12, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12063.66 } ] } ] }, { "description": "US Preg Uterus Ea Addl Gestation", "code_information": [ { "code": "76812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 180.0, "minimum": 180.96, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "NM First Pass RVEF Add On", "code_information": [ { "code": "78496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 865.25, "discounted_cash": 250.0, "minimum": 160.7594, "maximum": 784.7817, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 370.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 363.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.76 } ] } ] }, { "description": "96377 APPLICATION ON-BODY INJECTOR", "code_information": [ { "code": "96377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.5, "discounted_cash": 46.0, "minimum": 46.835, "maximum": 146.4805, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 103.42, "10th_percentile": 103.42, "90th_percentile": 103.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.01, "10th_percentile": 56.01, "90th_percentile": 56.01, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 161.5, "10th_percentile": 161.5, "90th_percentile": 161.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.68, "10th_percentile": 51.68, "90th_percentile": 51.68, "count": "1 through 10" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "761", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 6725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6725.61 } ] } ] }, { "description": "Factor IX Activity", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.5, "discounted_cash": 167.0, "minimum": 154.0, "maximum": 524.6995, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 154.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.51 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 13714.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13714.12 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH CC", "code_information": [ { "code": "501", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 20608.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20608.32 } ] } ] }, { "description": "MRI Abdomen w+wo Contrast", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2887.25, "discounted_cash": 837.0, "minimum": 837.3025, "maximum": 2670.71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1039.41, "10th_percentile": 1039.41, "90th_percentile": 1039.41, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1001.3, "10th_percentile": 1001.3, "90th_percentile": 1001.3, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2312.98, "10th_percentile": 2312.98, "90th_percentile": 2312.98, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2072.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1003.92, "10th_percentile": 1003.92, "90th_percentile": 1036.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2887.25, "10th_percentile": 2887.25, "90th_percentile": 2887.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 923.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 2644.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 923.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 981.67, "10th_percentile": 923.92, "90th_percentile": 981.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 923.92, "10th_percentile": 923.92, "90th_percentile": 981.67, "count": "1 through 10" } ] } ] }, { "description": "NM I 123 MIBG per dose up to 15mCi", "code_information": [ { "code": "A9582", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13426.75, "minimum": 3893.7575, "maximum": 13426.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13426.75 } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "463", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23762.0, "minimum": 23762.44, "maximum": 67191.29, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67191.29 } ] } ] }, { "description": "Fentanyl Citrate Preservative Free (PF) Inj 100 MCG/2ML", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409909416", "type": "NDC" }, { "code": "J3010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" } ] } ] }, { "description": "CRP, High Sensitivity", "code_information": [ { "code": "86141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.5, "discounted_cash": 40.0, "minimum": 40.455, "maximum": 130.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.91, "10th_percentile": 101.91, "90th_percentile": 101.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 109.65, "10th_percentile": 109.65, "90th_percentile": 109.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 139.5, "10th_percentile": 131.5, "90th_percentile": 139.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.64, "10th_percentile": 44.64, "90th_percentile": 44.64, "count": "1 through 10" } ] } ] }, { "description": "Proinsulin Level", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.25, "discounted_cash": 59.0, "minimum": 59.2325, "maximum": 204.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.17 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 144.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.25 } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC", "code_information": [ { "code": "481", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 24692.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24692.02 } ] } ] }, { "description": "Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.5, "discounted_cash": 255.0, "minimum": 120.53, "maximum": 799.5205, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 138.13 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 24965.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24965.52 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 62408.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62408.5 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "407", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 26166.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26166.82 } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 15282.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "759", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 7823.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7823.17 } ] } ] }, { "description": "PT Evaluation Units, Low Complexity", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 122.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.47, "10th_percentile": 151.47, "90th_percentile": 151.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 10960.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10960.21 } ] } ] }, { "description": "Fibrinogen Level", "code_information": [ { "code": "85384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.75, "discounted_cash": 38.0, "minimum": 38.2075, "maximum": 119.4972, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 70.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 68.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.16, "10th_percentile": 42.16, "90th_percentile": 42.16, "count": "1 through 10" } ] } ] }, { "description": "RECTAL RESECTION WITH MCC", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14347.0, "minimum": 14347.14, "maximum": 42684.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42684.36 } ] } ] }, { "description": "Type, Body Fluid", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.25, "discounted_cash": 36.0, "minimum": 36.9025, "maximum": 115.4158, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 44.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.0, "10th_percentile": 120.0, "90th_percentile": 120.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 40.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 115.42, "10th_percentile": 115.42, "90th_percentile": 115.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 40.72, "count": "1 through 10" } ] } ] }, { "description": "Voriconazole Level", "code_information": [ { "code": "80285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.0, "discounted_cash": 69.0, "minimum": 69.6, "maximum": 240.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.0 } ] } ] }, { "description": "NM Tumor Imaging Multiple", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1782.75, "discounted_cash": 516.0, "minimum": 516.9975, "maximum": 1782.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 796.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1782.75 } ] } ] }, { "description": "XR Fluoro Guide Needle Loc", "code_information": [ { "code": "77003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 528.75, "discounted_cash": 153.0, "minimum": 123.0, "maximum": 528.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 123.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 528.75 } ] } ] }, { "description": "Biofeedback OT", "code_information": [ { "code": "90901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 34.0, "minimum": 34.8, "maximum": 108.84, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.75, "discounted_cash": 70.0, "minimum": 70.9775, "maximum": 221.9882, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 117.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 244.75, "10th_percentile": 244.75, "90th_percentile": 244.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 83.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.32, "10th_percentile": 78.32, "90th_percentile": 78.32, "count": "1 through 10" } ] } ] }, { "description": "Testos Free Male ED/LC-MS/MS", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 357.75, "discounted_cash": 103.0, "minimum": 103.7475, "maximum": 324.4792, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 210.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 257.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 206.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 236.12 } ] } ] }, { "description": "Chromium, Blood", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.5, "discounted_cash": 30.0, "minimum": 30.885, "maximum": 106.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 106.5, "10th_percentile": 106.5, "90th_percentile": 106.5, "count": "1 through 10" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 7898.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7898.62 } ] } ] }, { "description": "IR Hepatic Portogram w Press 75887", "code_information": [ { "code": "75887", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3164.5, "discounted_cash": 917.0, "minimum": 617.5646, "maximum": 2870.2015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 854.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1047.54 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 838.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "Carboxyhemoglobin", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.5, "discounted_cash": 51.0, "minimum": 51.185, "maximum": 160.0855, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 124.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 99.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.21 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.31, "10th_percentile": 65.31, "90th_percentile": 65.31, "count": "1 through 10" } ] } ] }, { "description": "PREMATURITY WITH MAJOR PROBLEMS", "code_information": [ { "code": "791", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29815.0, "minimum": 29815.14, "maximum": 47851.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47851.47 } ] } ] }, { "description": "Reptilase Time (Patient)", "code_information": [ { "code": "85635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 35.0, "minimum": 35.09, "maximum": 109.747, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 79.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.31 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 20715.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20715.6 } ] } ] }, { "description": "TX FINGER DISLOC MAN FAC", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.75, "discounted_cash": 99.0, "minimum": 99.1075, "maximum": 309.9672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.03, "10th_percentile": 123.03, "90th_percentile": 123.03, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 341.75, "10th_percentile": 341.75, "90th_percentile": 341.75, "count": "1 through 10" } ] } ] }, { "description": "Interleukin 6, Serum", "code_information": [ { "code": "83529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.0, "discounted_cash": 75.0, "minimum": 75.4, "maximum": 235.82, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.1 } ] } ] }, { "description": "XR Knee Left 2 Views", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.5, "discounted_cash": 50.0, "minimum": 50.895, "maximum": 175.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 118.5, "10th_percentile": 118.5, "90th_percentile": 118.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.58, "10th_percentile": 59.58, "90th_percentile": 63.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.86, "10th_percentile": 57.4, "90th_percentile": 60.86, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 111.79, "10th_percentile": 111.79, "90th_percentile": 111.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 137.94, "10th_percentile": 132.58, "90th_percentile": 137.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 52.96, "90th_percentile": 175.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 175.5, "10th_percentile": 165.5, "90th_percentile": 175.5, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 52.96, "90th_percentile": 56.16, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 159.18, "10th_percentile": 56.16, "90th_percentile": 159.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 56.16, "90th_percentile": 56.16, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.96, "10th_percentile": 52.96, "90th_percentile": 56.27, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.16, "10th_percentile": 56.16, "90th_percentile": 56.27, "count": "1 through 10" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 26375.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26375.48 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 62868.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62868.27 } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9520.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9520.78 } ] } ] }, { "description": "XR Arthrogram TMJ", "code_information": [ { "code": "70332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1117.0, "discounted_cash": 323.0, "minimum": 227.36, "maximum": 1013.119, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 231.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 284.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 227.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.01 } ] } ] }, { "description": "Herpes Simplex Virus by PCR", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 77.0, "minimum": 77.2125, "maximum": 266.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 241.49, "10th_percentile": 241.49, "90th_percentile": 241.49, "count": "1 through 10" } ] } ] }, { "description": "NM Radiopharm Dacryocystography", "code_information": [ { "code": "78660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 287.0, "minimum": 287.1, "maximum": 947.4149, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 538.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 659.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 527.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "Acute Neb Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.25, "discounted_cash": 24.0, "minimum": 24.1425, "maximum": 75.5078, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.41, "10th_percentile": 23.41, "90th_percentile": 24.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 25.5, "10th_percentile": 25.5, "90th_percentile": 71.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" } ] } ] }, { "description": "Ther Ivntj EA Addl 15 Min OT", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 26.0, "minimum": 26.97, "maximum": 93.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.0 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12051.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12051.87 } ] } ] }, { "description": "VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 9728.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9728.27 } ] } ] }, { "description": "XR Cervical Port Lat Min 4 Views", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.25, "discounted_cash": 182.0, "minimum": 143.02, "maximum": 571.6368, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 425.66, "10th_percentile": 425.66, "90th_percentile": 425.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 214.02, "10th_percentile": 214.02, "90th_percentile": 226.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 178.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 143.02 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 218.58, "10th_percentile": 206.17, "90th_percentile": 218.58, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 401.47, "10th_percentile": 401.47, "90th_percentile": 722.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 346.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 83.7, "90th_percentile": 201.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 630.25, "10th_percentile": 594.5, "90th_percentile": 630.25, "count": "25" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 190.24, "10th_percentile": 190.24, "90th_percentile": 201.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 571.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 106.42, "90th_percentile": 219.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 202.13, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 201.68, "count": "1 through 10" } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "831", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 14176.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14176.25 } ] } ] }, { "description": "Haloperidol Level", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.75, "discounted_cash": 139.0, "minimum": 117.81, "maximum": 436.9472, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 117.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.53, "10th_percentile": 110.53, "90th_percentile": 110.53, "count": "1 through 10" } ] } ] }, { "description": "BD DXA Bone Density Axial", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.25, "discounted_cash": 192.0, "minimum": 192.0525, "maximum": 600.6608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 447.32, "10th_percentile": 447.32, "90th_percentile": 447.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 238.41, "10th_percentile": 224.91, "90th_percentile": 238.41, "count": "20" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 249.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 305.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 244.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.67, "10th_percentile": 216.67, "90th_percentile": 229.67, "count": "27" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 421.85, "10th_percentile": 421.85, "90th_percentile": 421.85, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 520.53, "10th_percentile": 520.53, "90th_percentile": 520.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 84.67, "90th_percentile": 382.8, "count": "31" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 662.25, "10th_percentile": 624.75, "90th_percentile": 662.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 211.92, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 572.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 199.92, "90th_percentile": 231.16, "count": "44" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 211.92, "90th_percentile": 212.42, "count": "32" } ] } ] }, { "description": "Insulin, Random", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.75, "discounted_cash": 52.0, "minimum": 52.9975, "maximum": 165.7543, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 182.75, "10th_percentile": 182.75, "90th_percentile": 182.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.4, "10th_percentile": 167.4, "90th_percentile": 167.4, "count": "1 through 10" } ] } ] }, { "description": "Blood type antigen donor ea", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.0, "discounted_cash": 56.0, "minimum": 29.81, "maximum": 175.958, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.87 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "743", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 14626.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14626.59 } ] } ] }, { "description": "88307 AP Bill Surgical Pathology Level V Complexity", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.25, "discounted_cash": 179.0, "minimum": 179.5825, "maximum": 619.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.25 } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 17022.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17022.11 } ] } ] }, { "description": "VL Duplex Scan Abd Viscera Limited - Vascular US Charges", "code_information": [ { "code": "93976", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1626.25, "discounted_cash": 471.0, "minimum": 471.6125, "maximum": 1475.0087, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 412.1, "10th_percentile": 412.1, "90th_percentile": 412.1, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 497.74, "10th_percentile": 497.74, "90th_percentile": 515.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 607.0, "10th_percentile": 607.0, "90th_percentile": 607.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 205.92, "10th_percentile": 205.92, "90th_percentile": 205.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 205.92, "10th_percentile": 205.92, "90th_percentile": 205.92, "count": "1 through 10" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 19603.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19603.89 } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9215.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9215.45 } ] } ] }, { "description": "Rituxan Sensitivity (CD20)", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 89.0, "minimum": 89.0, "maximum": 278.6757, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 289.75, "10th_percentile": 289.75, "90th_percentile": 307.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 92.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.52, "10th_percentile": 98.52, "90th_percentile": 98.52, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL Agn Pheno per Unit", "code_information": [ { "code": "86906", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539.75, "discounted_cash": 156.0, "minimum": 62.68, "maximum": 489.5532, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.34 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.85 } ] } ] }, { "description": "$ AP 88321 Consult", "code_information": [ { "code": "88321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1095.25, "discounted_cash": 317.0, "minimum": 317.6225, "maximum": 1095.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1095.25 } ] } ] }, { "description": "Echo Myocardial Strain Imaging", "code_information": [ { "code": "93356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 12.0, "minimum": 12.18, "maximum": 38.094, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 28.64, "10th_percentile": 28.64, "90th_percentile": 28.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 25.62, "10th_percentile": 25.62, "90th_percentile": 26.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.87, "10th_percentile": 13.87, "90th_percentile": 13.87, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 40.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 36.28, "10th_percentile": 36.28, "90th_percentile": 863.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 863.13, "10th_percentile": 801.91, "90th_percentile": 863.13, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.8, "10th_percentile": 12.8, "90th_percentile": 12.8, "count": "1 through 10" } ] } ] }, { "description": "Trazodone (Desyrel) Level", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 350.5, "discounted_cash": 101.0, "minimum": 101.645, "maximum": 317.9035, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.2 } ] } ] }, { "description": "Hepatitis A IgM", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 53.0, "minimum": 53.07, "maximum": 165.981, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 123.69, "10th_percentile": 123.69, "90th_percentile": 123.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.91, "10th_percentile": 59.91, "90th_percentile": 59.91, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 143.84, "10th_percentile": 143.84, "90th_percentile": 143.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 172.75, "10th_percentile": 172.75, "90th_percentile": 183.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.28, "10th_percentile": 55.28, "90th_percentile": 55.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.28, "10th_percentile": 55.28, "90th_percentile": 55.28, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL PreTx Chem or Drug Ea", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 33.0, "minimum": 33.64, "maximum": 116.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 } ] } ] }, { "description": "Ketorolac Tromethamine IM Inj 60 MG/2ML (30 MG/ML)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "25021070102", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "VL Duplex Scan Carotid Bilat - Vascular US Charges", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1476.5, "discounted_cash": 428.0, "minimum": 428.185, "maximum": 1339.1855, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 857.23, "10th_percentile": 857.23, "90th_percentile": 857.23, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 431.01, "10th_percentile": 431.01, "90th_percentile": 431.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 766.72, "10th_percentile": 766.72, "90th_percentile": 781.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 415.21, "10th_percentile": 415.21, "90th_percentile": 415.21, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 981.75, "10th_percentile": 981.75, "90th_percentile": 981.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 941.04, "10th_percentile": 941.04, "90th_percentile": 941.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 407.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1197.25, "10th_percentile": 1197.25, "90th_percentile": 1197.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 383.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 383.12, "10th_percentile": 383.12, "90th_percentile": 442.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 407.07, "10th_percentile": 407.07, "90th_percentile": 407.07, "count": "1 through 10" } ] } ] }, { "description": "CT Cervical Spine wo Contrast", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1705.5, "discounted_cash": 494.0, "minimum": 494.595, "maximum": 1546.8885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1246.98, "10th_percentile": 660.88, "90th_percentile": 1246.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 579.24, "10th_percentile": 306.99, "90th_percentile": 613.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 558.0, "10th_percentile": 558.0, "90th_percentile": 591.47, "count": "1 through 10" }, { "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": 733.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1705.5, "10th_percentile": 1609.0, "90th_percentile": 1705.5, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1473.84, "10th_percentile": 1473.84, "90th_percentile": 1473.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 545.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 547.06, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 545.76, "10th_percentile": 514.88, "90th_percentile": 547.06, "count": "1 through 10" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 8511.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8511.64 } ] } ] }, { "description": "NM First Pass Multi", "code_information": [ { "code": "78483", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.5, "discounted_cash": 97.0, "minimum": 97.295, "maximum": 335.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.5 } ] } ] }, { "description": "Bill IRL PreTx Serum Ea", "code_information": [ { "code": "86975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 717.5, "discounted_cash": 208.0, "minimum": 208.075, "maximum": 650.7725, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 348.29 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "989", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 14137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14137.34 } ] } ] }, { "description": "Methemoglobin", "code_information": [ { "code": "83050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.75, "discounted_cash": 32.0, "minimum": 32.9875, "maximum": 103.1713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.05 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 59.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.02 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITHOUT CCMCC", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8886.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8886.53 } ] } ] }, { "description": "Cobalt, Serum/Plasma", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.75, "discounted_cash": 23.0, "minimum": 23.4175, "maximum": 80.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC", "code_information": [ { "code": "456", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21072.0, "minimum": 21072.36, "maximum": 99067.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99067.51 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 25668.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25668.15 } ] } ] }, { "description": "XR Lower Extremity Infant 2 Views Left", "code_information": [ { "code": "73592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.25, "discounted_cash": 138.0, "minimum": 77.24, "maximum": 432.8657, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "Lysozyme (Muramidase)", "code_information": [ { "code": "85549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 13.0, "minimum": 13.05, "maximum": 45.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 } ] } ] }, { "description": "CT Pelvis w+wo Contrast", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2669.0, "discounted_cash": 774.0, "minimum": 650.0, "maximum": 2420.783, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 906.48, "10th_percentile": 906.48, "90th_percentile": 906.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1714.4 } ] } ] }, { "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": 8518.0, "minimum": 8518.61, "maximum": 25920.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25920.43 } ] } ] }, { "description": "Factor XII, Activity", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.25, "discounted_cash": 83.0, "minimum": 83.5925, "maximum": 261.4427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 } ] } ] }, { "description": "Hepatitis Be Antibody", "code_information": [ { "code": "86707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 33.0, "minimum": 33.4225, "maximum": 115.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.88, "10th_percentile": 36.88, "90th_percentile": 36.88, "count": "1 through 10" } ] } ] }, { "description": "UA w/Reflex to Sediment Exam", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.5, "discounted_cash": 14.0, "minimum": 14.645, "maximum": 45.8035, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 36.16, "10th_percentile": 33.12, "90th_percentile": 36.16, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.18, "10th_percentile": 16.65, "90th_percentile": 23.31, "count": "24" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 18.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.51, "10th_percentile": 16.04, "90th_percentile": 17.51, "count": "26" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 40.45, "10th_percentile": 32.17, "90th_percentile": 41.41, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2.25, "10th_percentile": 2.25, "90th_percentile": 17.17, "count": "11" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.5, "10th_percentile": 46.25, "90th_percentile": 50.5, "count": "194" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 2.25, "90th_percentile": 17.17, "count": "80" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 36.97, "10th_percentile": 16.16, "90th_percentile": 46.26, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 18.69, "count": "48" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 17.17, "count": "30" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 14.8, "90th_percentile": 20.72, "count": "19" } ] } ] }, { "description": "NM Thyroid Carcinoma Mets Uptake", "code_information": [ { "code": "78020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.0, "discounted_cash": 124.0, "minimum": 124.7, "maximum": 430.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 243.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 238.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 430.0 } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 9918.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9918.07 } ] } ] }, { "description": "Hematocrit", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 10.0, "minimum": 10.15, "maximum": 31.745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.6, "10th_percentile": 11.88, "90th_percentile": 12.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.14, "10th_percentile": 11.44, "90th_percentile": 12.14, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 21.02, "10th_percentile": 21.02, "90th_percentile": 21.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "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": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 33.0, "10th_percentile": 33.0, "90th_percentile": 35.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.56, "10th_percentile": 10.56, "90th_percentile": 11.2, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 10.56, "10th_percentile": 10.56, "90th_percentile": 26.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 12.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 10.56, "90th_percentile": 11.22, "count": "27" } ] } ] }, { "description": "ED US EXAM CHEST FAC", "code_information": [ { "code": "76604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.25, "discounted_cash": 124.0, "minimum": 124.4825, "maximum": 389.3297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.36, "10th_percentile": 137.36, "90th_percentile": 137.36, "count": "1 through 10" } ] } ] }, { "description": "zzKOH Prep", "code_information": [ { "code": "87220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 26.0, "minimum": 26.68, "maximum": 83.444, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 32.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 292.17, "10th_percentile": 292.17, "90th_percentile": 292.17, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23762.0, "minimum": 23762.44, "maximum": 115329.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 115329.23 } ] } ] }, { "description": "Cyclic Citrullinated Peptide Ab, IgG", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.0, "discounted_cash": 52.0, "minimum": 52.2, "maximum": 163.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 131.56, "10th_percentile": 131.56, "90th_percentile": 138.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 64.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.53, "10th_percentile": 70.53, "90th_percentile": 70.53, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 131.56, "10th_percentile": 131.56, "90th_percentile": 131.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 169.75, "10th_percentile": 169.75, "90th_percentile": 180.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 54.32, "90th_percentile": 57.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 62.81, "10th_percentile": 62.81, "90th_percentile": 62.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 62.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 57.6, "count": "1 through 10" } ] } ] }, { "description": "Carbon Monoxide Diffusion Cap", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.0, "discounted_cash": 84.0, "minimum": 84.39, "maximum": 263.937, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.76, "10th_percentile": 99.81, "90th_percentile": 104.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 186.36, "10th_percentile": 180.96, "90th_percentile": 186.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 100.92, "10th_percentile": 96.16, "90th_percentile": 100.92, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 227.35, "10th_percentile": 227.35, "90th_percentile": 227.35, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.11, "10th_percentile": 222.11, "90th_percentile": 222.11, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 277.25, "10th_percentile": 1.14, "90th_percentile": 291.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 291.0, "10th_percentile": 277.25, "90th_percentile": 291.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 88.72, "90th_percentile": 93.12, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 263.94, "10th_percentile": 221.61, "90th_percentile": 422.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 376.91, "10th_percentile": 88.72, "90th_percentile": 422.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.12, "10th_percentile": 93.12, "90th_percentile": 93.12, "count": "1 through 10" } ] } ] }, { "description": "US Obstetrical Complete 14+ Wk", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 897.5, "discounted_cash": 260.0, "minimum": 260.275, "maximum": 814.0325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 475.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 380.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 752.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 897.5, "10th_percentile": 846.75, "90th_percentile": 897.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 814.03, "10th_percentile": 814.03, "90th_percentile": 814.03, "count": "1 through 10" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 31799.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31799.59 } ] } ] }, { "description": "Zonisamide Level", "code_information": [ { "code": "80203", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.5, "discounted_cash": 49.0, "minimum": 49.735, "maximum": 155.5505, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.76, "10th_percentile": 51.76, "90th_percentile": 51.76, "count": "1 through 10" } ] } ] }, { "description": "XR Sialogram", "code_information": [ { "code": "70390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 791.0, "discounted_cash": 229.0, "minimum": 229.39, "maximum": 791.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 319.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 391.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 313.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 791.0 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "346", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 13984.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13984.09 } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC", "code_information": [ { "code": "939", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 42776.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42776.31 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 49702.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49702.34 } ] } ] }, { "description": "US AAA Screening", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 706.25, "discounted_cash": 204.0, "minimum": 204.8125, "maximum": 685.1736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 254.25, "10th_percentile": 239.85, "90th_percentile": 254.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 473.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 378.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 231.06, "10th_percentile": 231.06, "90th_percentile": 231.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 685.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 213.2, "90th_percentile": 226.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 666.25, "10th_percentile": 666.25, "90th_percentile": 666.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 213.2, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 213.2, "10th_percentile": 213.2, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.0, "10th_percentile": 226.0, "90th_percentile": 226.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.53, "10th_percentile": 226.53, "90th_percentile": 226.53, "count": "1 through 10" } ] } ] }, { "description": "Rubeola (Measles) Ab, IgG", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 13.0, "minimum": 13.05, "maximum": 45.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 34.05, "10th_percentile": 34.05, "90th_percentile": 34.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 42.5, "10th_percentile": 42.5, "90th_percentile": 45.0, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.4, "10th_percentile": 13.6, "90th_percentile": 14.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 38.93, "10th_percentile": 38.93, "90th_percentile": 40.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.4, "10th_percentile": 14.4, "90th_percentile": 14.4, "count": "1 through 10" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 9438.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9438.26 } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 20796.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20796.94 } ] } ] }, { "description": "Islet Cell Antibody, IgG", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.0, "discounted_cash": 44.0, "minimum": 44.95, "maximum": 155.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.25, "10th_percentile": 146.25, "90th_percentile": 146.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.6, "10th_percentile": 49.6, "90th_percentile": 54.11, "count": "1 through 10" } ] } ] }, { "description": "75774 FAC ANGIOGRPHY SLCT EA AD VSL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2456.0, "discounted_cash": 712.0, "minimum": 431.4006, "maximum": 2227.592, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 808.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.34 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 792.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 431.4 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "722", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 21334.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21334.52 } ] } ] }, { "description": "Spirometry w/o Bronchodilator", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.25, "discounted_cash": 98.0, "minimum": 98.3825, "maximum": 307.6997, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 116.28, "10th_percentile": 116.28, "90th_percentile": 116.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 117.66, "10th_percentile": 117.66, "90th_percentile": 117.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 339.25, "10th_percentile": 339.25, "90th_percentile": 339.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 339.25, "10th_percentile": 339.25, "90th_percentile": 339.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.56, "10th_percentile": 108.56, "90th_percentile": 108.56, "count": "1 through 10" } ] } ] }, { "description": "Developmental Testing 1st Hr OT", "code_information": [ { "code": "96112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.5, "discounted_cash": 100.0, "minimum": 95.0, "maximum": 315.1825, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 81083.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81083.43 } ] } ] }, { "description": "Echo Doppler Limited", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 508.25, "discounted_cash": 147.0, "minimum": 147.3925, "maximum": 460.9828, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 393.89, "10th_percentile": 393.89, "90th_percentile": 393.89, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 325.48, "10th_percentile": 325.48, "90th_percentile": 331.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 176.27, "10th_percentile": 176.27, "90th_percentile": 176.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 406.24, "10th_percentile": 406.24, "90th_percentile": 406.24, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 367.37, "10th_percentile": 367.37, "90th_percentile": 367.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 508.25, "10th_percentile": 508.25, "90th_percentile": 508.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 172.81, "10th_percentile": 162.64, "90th_percentile": 172.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.61, "10th_percentile": 32.53, "90th_percentile": 162.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.64, "10th_percentile": 162.64, "90th_percentile": 162.64, "count": "1 through 10" } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "499", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 23752.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23752.44 } ] } ] }, { "description": "MRI Breast Bilat Post Clip 77047", "code_information": [ { "code": "77047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.25, "discounted_cash": 286.0, "minimum": 286.5925, "maximum": 988.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.25 } ] } ] }, { "description": "76932 FAC US GDNC VASC ACCESS", "code_information": [ { "code": "76932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 688.25, "discounted_cash": 199.0, "minimum": 199.5925, "maximum": 624.2428, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 250.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 245.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 507.55 } ] } ] }, { "description": "SIM REP TRK <2.5 FAC", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.25, "discounted_cash": 100.0, "minimum": 100.1225, "maximum": 313.1418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 265.15, "10th_percentile": 254.78, "90th_percentile": 265.15, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.29, "10th_percentile": 118.35, "90th_percentile": 124.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 273.09, "10th_percentile": 273.09, "90th_percentile": 273.09, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.02, "10th_percentile": 114.02, "90th_percentile": 119.74, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 269.58, "10th_percentile": 269.58, "90th_percentile": 276.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 271.37, "10th_percentile": 271.37, "90th_percentile": 271.37, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 254.78, "10th_percentile": 254.78, "90th_percentile": 254.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 345.25, "10th_percentile": 328.75, "90th_percentile": 345.25, "count": "41" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.48, "10th_percentile": 105.2, "90th_percentile": 111.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 301.14, "10th_percentile": 301.14, "90th_percentile": 301.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.2, "10th_percentile": 105.2, "90th_percentile": 110.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.48, "10th_percentile": 105.2, "90th_percentile": 111.78, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.48, "10th_percentile": 110.48, "90th_percentile": 110.48, "count": "1 through 10" } ] } ] }, { "description": "I-D BARTH GLAND ABSCESS FAC", "code_information": [ { "code": "56420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 546.5, "discounted_cash": 158.0, "minimum": 158.485, "maximum": 495.6755, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 546.5, "10th_percentile": 546.5, "90th_percentile": 546.5, "count": "1 through 10" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 49787.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49787.22 } ] } ] }, { "description": "Bill HLA ABC Type", "code_information": [ { "code": "86813", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 548.25, "discounted_cash": 158.0, "minimum": 158.9925, "maximum": 548.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 478.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 548.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 469.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 537.69 } ] } ] }, { "description": "B miyamotoi Ab IgG", "code_information": [ { "code": "86619", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222.0, "discounted_cash": 64.0, "minimum": 64.38, "maximum": 201.354, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 108.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.04 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12852.054, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10557.03 } ] } ] }, { "description": "XR Bone Age Study", "code_information": [ { "code": "77072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.75, "discounted_cash": 146.0, "minimum": 54.36, "maximum": 457.8082, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 54.36 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 381.52, "10th_percentile": 381.52, "90th_percentile": 381.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.82 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 504.75, "10th_percentile": 504.75, "90th_percentile": 504.75, "count": "1 through 10" } ] } ] }, { "description": "MRI Thoracic Spine wo Contrast", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2090.25, "discounted_cash": 606.0, "minimum": 606.1725, "maximum": 1895.8567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 752.49, "10th_percentile": 752.49, "90th_percentile": 752.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1068.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2090.25, "10th_percentile": 2090.25, "90th_percentile": 2090.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 668.88, "10th_percentile": 668.88, "90th_percentile": 668.88, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CCMCC", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 8068.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8068.38 } ] } ] }, { "description": "Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.75, "discounted_cash": 28.0, "minimum": 28.6375, "maximum": 89.5662, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 59.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.67 } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "655", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 24952.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24952.56 } ] } ] }, { "description": "Beta-Hydroxybutyrate, Blood", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.75, "discounted_cash": 22.0, "minimum": 22.5475, "maximum": 77.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 66.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.97, "10th_percentile": 26.97, "90th_percentile": 26.97, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.75, "10th_percentile": 77.75, "90th_percentile": 77.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.77, "10th_percentile": 28.77, "90th_percentile": 28.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 24.88, "90th_percentile": 24.88, "count": "1 through 10" } ] } ] }, { "description": "DAT, IgG (Autmated)", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.5, "discounted_cash": 24.0, "minimum": 24.505, "maximum": 76.6415, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 80.25, "10th_percentile": 80.25, "90th_percentile": 208.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.68, "10th_percentile": 25.68, "90th_percentile": 92.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.29, "10th_percentile": 27.29, "90th_percentile": 27.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.97 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 16108.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16108.46 } ] } ] }, { "description": "XR Neck Soft Tissue 1 View", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.75, "discounted_cash": 99.0, "minimum": 71.49, "maximum": 310.8743, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 315.5, "10th_percentile": 161.63, "90th_percentile": 334.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.96, "10th_percentile": 100.96, "90th_percentile": 100.96, "count": "1 through 10" } ] } ] }, { "description": "HLA B27", "code_information": [ { "code": "86812", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.75, "discounted_cash": 79.0, "minimum": 79.0975, "maximum": 261.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 209.47, "10th_percentile": 209.47, "90th_percentile": 209.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 208.81 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 163.87, "10th_percentile": 163.87, "90th_percentile": 163.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.27 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 257.25, "10th_percentile": 257.25, "90th_percentile": 272.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 247.38, "10th_percentile": 247.38, "90th_percentile": 247.38, "count": "1 through 10" } ] } ] }, { "description": "Toxocara canis Ab, IgG", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 98.0, "minimum": 78.97, "maximum": 306.566, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 203.04, "10th_percentile": 203.04, "90th_percentile": 203.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.4 } ] } ] }, { "description": "Vitamin B12 Level", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.5, "discounted_cash": 63.0, "minimum": 63.075, "maximum": 197.2725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 155.73, "10th_percentile": 155.73, "90th_percentile": 155.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.3, "10th_percentile": 78.3, "90th_percentile": 78.3, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 123.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.08 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.43, "10th_percentile": 75.43, "90th_percentile": 75.43, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 138.55, "10th_percentile": 138.55, "90th_percentile": 174.22, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 170.96, "10th_percentile": 170.96, "90th_percentile": 174.24, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.15, "10th_percentile": 2.73, "90th_percentile": 217.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 50.56, "10th_percentile": 50.56, "90th_percentile": 50.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 217.5, "10th_percentile": 217.5, "90th_percentile": 217.5, "count": "125" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 173.85, "10th_percentile": 69.6, "90th_percentile": 197.27, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 69.6, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 73.95, "count": "24" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.6, "10th_percentile": 69.6, "90th_percentile": 73.95, "count": "24" } ] } ] }, { "description": "CT Sinuses w+wo Contrast", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1999.25, "discounted_cash": 579.0, "minimum": 579.7825, "maximum": 1813.3198, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "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": 1096.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1886.0, "10th_percentile": 1886.0, "90th_percentile": 1886.0, "count": "1 through 10" } ] } ] }, { "description": "Cholinesterase, Plasma", "code_information": [ { "code": "82482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.0, "discounted_cash": 31.0, "minimum": 31.03, "maximum": 97.049, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.94 } ] } ] }, { "description": "MA Mammo Bilat Screen w CAD Digital", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.0, "discounted_cash": 154.0, "minimum": 154.86, "maximum": 534.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 382.34, "10th_percentile": 382.34, "90th_percentile": 382.34, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 192.24, "10th_percentile": 192.24, "90th_percentile": 192.24, "count": "64" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 406.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.19, "10th_percentile": 185.19, "90th_percentile": 185.19, "count": "51" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 340.16, "10th_percentile": 340.16, "90th_percentile": 340.16, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 419.72, "10th_percentile": 419.72, "90th_percentile": 427.79, "count": "33" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 534.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "64" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 115.7, "10th_percentile": 115.7, "90th_percentile": 410.11, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 83.56, "10th_percentile": 83.56, "90th_percentile": 85.16, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.72, "10th_percentile": 81.72, "90th_percentile": 83.79, "count": "136" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 426.83, "10th_percentile": 115.41, "90th_percentile": 489.14, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.41, "10th_percentile": 115.41, "90th_percentile": 117.63, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.88, "10th_percentile": 170.88, "90th_percentile": 181.56, "count": "53" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 37129.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37129.39 } ] } ] }, { "description": "NM MUGA Gated Cardiac Single Planar", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1234.5, "discounted_cash": 358.0, "minimum": 358.005, "maximum": 1234.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1234.5 } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "628", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 43935.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43935.17 } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 40924.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40924.27 } ] } ] }, { "description": "Natural Killer Cell Enumeration", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.5, "discounted_cash": 72.0, "minimum": 72.065, "maximum": 248.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 150.13, "10th_percentile": 150.13, "90th_percentile": 150.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.5 } ] } ] }, { "description": "INR", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.75, "discounted_cash": 23.0, "minimum": 23.1275, "maximum": 72.3333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 51.37, "10th_percentile": 51.37, "90th_percentile": 61.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.71, "10th_percentile": 25.83, "90th_percentile": 28.71, "count": "29" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.81 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.66, "10th_percentile": 24.89, "90th_percentile": 27.66, "count": "130" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 50.8, "10th_percentile": 50.8, "90th_percentile": 50.8, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 62.68, "10th_percentile": 57.48, "90th_percentile": 62.68, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.76, "10th_percentile": 3.28, "90th_percentile": 71.75, "count": "38" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 79.75, "10th_percentile": 71.75, "90th_percentile": 79.75, "count": "197" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.4, "10th_percentile": 14.08, "90th_percentile": 25.52, "count": "209" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 65.72, "10th_percentile": 65.72, "90th_percentile": 65.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "155" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "47" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.52, "10th_percentile": 22.96, "90th_percentile": 25.52, "count": "164" } ] } ] }, { "description": "INT REP HAND FT 7.6-12 FAC", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 162.0, "minimum": 162.0375, "maximum": 506.7862, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 558.75, "10th_percentile": 558.75, "90th_percentile": 558.75, "count": "1 through 10" } ] } ] }, { "description": "RENAL FAILURE WITH MCC", "code_information": [ { "code": "682", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 5271.3299, "maximum": 17459.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17459.48 } ] } ] }, { "description": "Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.0, "discounted_cash": 270.0, "minimum": 270.28, "maximum": 845.324, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 531.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 651.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 521.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.11 } ] } ] }, { "description": "NM Cardiac Amyloid SPECT NC 78803", "code_information": [ { "code": "78803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4947.75, "discounted_cash": 1434.0, "minimum": 1161.22, "maximum": 4487.6093, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1184.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1451.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1161.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2520.86 } ] } ] }, { "description": "Clearance Creatinine Blood", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 14.0, "minimum": 14.5, "maximum": 50.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 38.4, "10th_percentile": 38.4, "90th_percentile": 38.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 18.0, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.45 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.34, "10th_percentile": 17.34, "90th_percentile": 17.34, "count": "23" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.85, "10th_percentile": 31.85, "90th_percentile": 31.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.0, "10th_percentile": 16.65, "90th_percentile": 50.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 45.35, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 18.5, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 17.0, "count": "13" } ] } ] }, { "description": "99291 - Critical Care - Lynx Visit Level", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4193.0, "discounted_cash": 1215.0, "minimum": 1215.97, "maximum": 3803.051, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 3220.22, "10th_percentile": 3220.22, "90th_percentile": 3220.22, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2920.81, "10th_percentile": 2920.81, "90th_percentile": 2920.81, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2096.5, "10th_percentile": 2054.6, "90th_percentile": 2891.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4193.0, "10th_percentile": 4193.0, "90th_percentile": 4193.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1341.76, "10th_percentile": 1341.76, "90th_percentile": 3803.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1166.72, "90th_percentile": 1341.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1341.76, "10th_percentile": 1341.76, "90th_percentile": 1341.76, "count": "1 through 10" } ] } ] }, { "description": "Crossmatch Immediate Spin Interpretation", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.5, "discounted_cash": 24.0, "minimum": 24.505, "maximum": 84.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 54.08, "count": "1 through 10" } ] } ] }, { "description": "Serotonin Level", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.75, "discounted_cash": 90.0, "minimum": 90.6975, "maximum": 312.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 255.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 312.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 250.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 287.2 } ] } ] }, { "description": "Bill TPMT Enzyme Quant HPLC for 6-MTG", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 867.5, "discounted_cash": 251.0, "minimum": 146.13, "maximum": 786.8225, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.33 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 867.5, "10th_percentile": 209.75, "90th_percentile": 867.5, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "515", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15019.0, "minimum": 15019.66, "maximum": 37570.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37570.3 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2465.0, "minimum": 2465.91, "maximum": 5365.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 5365.16 } ] } ] }, { "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": 16140.0, "minimum": 16140.53, "maximum": 65619.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 65619.82 } ] } ] }, { "description": "MRI Angio Head w Contrast", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1947.5, "discounted_cash": 564.0, "minimum": 564.775, "maximum": 1947.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "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": 1502.97 } ] } ] }, { "description": "Glucose, Test Strip POC", "code_information": [ { "code": "82948", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.25, "discounted_cash": 4.0, "minimum": 4.4225, "maximum": 15.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 15.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.25 } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITH CCMCC", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 25582.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25582.09 } ] } ] }, { "description": "$ AP 88356 Morphometric, Nerve", "code_information": [ { "code": "88356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 945.25, "discounted_cash": 274.0, "minimum": 274.1225, "maximum": 945.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 945.25 } ] } ] }, { "description": "US RIGHT EXT COMP", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.0, "discounted_cash": 155.0, "minimum": 93.082, "maximum": 485.245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 454.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 363.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.08 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 18474.939, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7399.94 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC", "code_information": [ { "code": "957", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22641.0, "minimum": 22641.57, "maximum": 89830.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89830.85 } ] } ] }, { "description": "Trich vag RNA, Ql, TMA, Males", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 85.0, "minimum": 85.405, "maximum": 294.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.19 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 196.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 294.5, "10th_percentile": 277.75, "90th_percentile": 294.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 102.77, "10th_percentile": 102.77, "90th_percentile": 102.77, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 8160.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8160.33 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15858.6189, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3044.77, "10th_percentile": 3044.77, "90th_percentile": 3044.77, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 16545.77, "10th_percentile": 16545.77, "90th_percentile": 20678.45, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 6720.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4802.14, "10th_percentile": 4802.14, "90th_percentile": 4802.14, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15134.69 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18382.0, "minimum": 18382.27, "maximum": 90519.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90519.33 } ] } ] }, { "description": "NM Brain SPECT CT 78835", "code_information": [ { "code": "78835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 897.75, "discounted_cash": 260.0, "minimum": 260.3475, "maximum": 814.2592, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.02 } ] } ] }, { "description": "Iontophoresis/15 min OT", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "discounted_cash": 29.0, "minimum": 29.87, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 13795.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13795.46 } ] } ] }, { "description": "Dexamethasone Sodium Phosphate Inj 4 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016502", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 15.47, "10th_percentile": 13.54, "90th_percentile": 25.78, "count": "1 through 10" } ] } ] }, { "description": "Streptozyme Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.0, "discounted_cash": 26.0, "minimum": 26.68, "maximum": 83.444, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 46.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.49 } ] } ] }, { "description": "Vitamin D, 1,25-Dihydroxy Level", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.75, "discounted_cash": 104.0, "minimum": 104.0375, "maximum": 358.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 317.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 311.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 356.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 358.75, "10th_percentile": 358.75, "90th_percentile": 358.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.5, "10th_percentile": 38.5, "90th_percentile": 38.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.8, "10th_percentile": 114.8, "90th_percentile": 114.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.8, "10th_percentile": 114.8, "90th_percentile": 114.8, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 19575.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19575.6 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH MCC", "code_information": [ { "code": "619", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 34039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34039.5 } ] } ] }, { "description": "Done - Newborn Hepatitis B Vaccine", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.5, "discounted_cash": 6.0, "minimum": 6.235, "maximum": 19.5005, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 16.51, "10th_percentile": 16.51, "90th_percentile": 16.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 7.74, "10th_percentile": 7.74, "90th_percentile": 7.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 13.77, "10th_percentile": 13.77, "90th_percentile": 13.77, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 7.46, "10th_percentile": 7.46, "90th_percentile": 7.46, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 17.63, "10th_percentile": 17.22, "90th_percentile": 17.63, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 17.18, "10th_percentile": 17.18, "90th_percentile": 17.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 21.5, "10th_percentile": 21.5, "90th_percentile": 21.5, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 17.18, "10th_percentile": 17.18, "90th_percentile": 19.69, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 6.88, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.88, "10th_percentile": 6.88, "90th_percentile": 7.31, "count": "1 through 10" } ] } ] }, { "description": "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CCMCC", "code_information": [ { "code": "538", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8491.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8491.6 } ] } ] }, { "description": "XR Mandible 1-3 Views", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 536.0, "discounted_cash": 155.0, "minimum": 82.95, "maximum": 486.152, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "SLP Swallow Function Study Units", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 425.25, "discounted_cash": 123.0, "minimum": 95.0, "maximum": 385.7018, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "HSV Type 1 Glycoprotein IgG", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 58.0, "minimum": 58.9425, "maximum": 184.3477, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 106.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.28 } ] } ] }, { "description": "Vitamin B3 (Niacin) Level", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.25, "discounted_cash": 77.0, "minimum": 77.5025, "maximum": 242.3957, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.08, "10th_percentile": 256.08, "90th_percentile": 256.08, "count": "1 through 10" } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC", "code_information": [ { "code": "354", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 19833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19833.78 } ] } ] }, { "description": "HIV-1 RNA by PCR", "code_information": [ { "code": "87536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 632.0, "discounted_cash": 183.0, "minimum": 183.28, "maximum": 632.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 463.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 568.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 454.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 632.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 632.0, "10th_percentile": 596.25, "90th_percentile": 632.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 202.24, "10th_percentile": 202.24, "90th_percentile": 202.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 190.8, "10th_percentile": 190.8, "90th_percentile": 190.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 190.8, "10th_percentile": 190.8, "90th_percentile": 202.24, "count": "1 through 10" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8399.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8399.65 } ] } ] }, { "description": "Beta 2 Microglobulin", "code_information": [ { "code": "82232", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 213.75, "discounted_cash": 61.0, "minimum": 61.9875, "maximum": 193.8713, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.53 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.62 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 130.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.4, "10th_percentile": 68.4, "90th_percentile": 68.4, "count": "1 through 10" } ] } ] }, { "description": "MRI Lumbar Spine w Contrast", "code_information": [ { "code": "72149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2126.25, "discounted_cash": 616.0, "minimum": 616.6125, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1646.73 } ] } ] }, { "description": "COVID-19 (on-site)", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.0, "discounted_cash": 42.0, "minimum": 42.34, "maximum": 146.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 112.13, "10th_percentile": 112.13, "90th_percentile": 112.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.78, "10th_percentile": 47.78, "90th_percentile": 47.78, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 46.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.72, "10th_percentile": 44.08, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.72, "10th_percentile": 46.72, "90th_percentile": 46.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.08, "10th_percentile": 44.08, "90th_percentile": 44.08, "count": "1 through 10" } ] } ] }, { "description": "Myelin Basic Protein", "code_information": [ { "code": "83873", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.5, "discounted_cash": 66.0, "minimum": 66.555, "maximum": 208.1565, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 142.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 139.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.45 } ] } ] }, { "description": "TP53 Somatic Mutation, Prognostic", "code_information": [ { "code": "81352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1800.0, "discounted_cash": 522.0, "minimum": 522.0, "maximum": 1800.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1800.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 462.65, "10th_percentile": 462.65, "90th_percentile": 462.65, "count": "1 through 10" } ] } ] }, { "description": "Fragile X (FMR1) Diagnostic", "code_information": [ { "code": "81244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1389.5, "discounted_cash": 402.0, "minimum": 156.27, "maximum": 1260.2765, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.34 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 416.15 } ] } ] }, { "description": "DHEA Sulfate", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.75, "discounted_cash": 87.0, "minimum": 87.2175, "maximum": 272.7803, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 183.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 224.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 179.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 206.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 300.75, "10th_percentile": 300.75, "90th_percentile": 300.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.78, "10th_percentile": 272.78, "90th_percentile": 272.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.24, "10th_percentile": 96.24, "90th_percentile": 96.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.24, "10th_percentile": 96.24, "90th_percentile": 96.24, "count": "1 through 10" } ] } ] }, { "description": "PSA (Prostate Specific Antigen) - G0103 - 3350213", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "minimum": 53.65, "maximum": 179.0134, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.6, "10th_percentile": 66.6, "90th_percentile": 66.6, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 183.84, "10th_percentile": 41.78, "90th_percentile": 185.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.9, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.9, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" } ] } ] }, { "description": "Pancreatic Elastase, Fecal", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.5, "discounted_cash": 108.0, "minimum": 104.79, "maximum": 339.6715, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 268.14, "10th_percentile": 268.14, "90th_percentile": 268.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.82, "10th_percentile": 134.82, "90th_percentile": 134.82, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.88, "10th_percentile": 129.88, "90th_percentile": 129.88, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 300.01, "10th_percentile": 300.01, "90th_percentile": 300.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 374.5, "10th_percentile": 195.0, "90th_percentile": 409.0, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 119.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.27, "10th_percentile": 17.27, "90th_percentile": 17.27, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.84, "10th_percentile": 119.84, "90th_percentile": 119.84, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17933.0, "minimum": 17933.92, "maximum": 69184.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69184.81 } ] } ] }, { "description": "75716 FAC LE ANGIO IMAGING BILAT", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8207.75, "discounted_cash": 2380.0, "minimum": 609.0963, "maximum": 7444.4293, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1025.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1256.65 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1005.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "MNT Initial", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.25, "discounted_cash": 35.0, "minimum": 35.1625, "maximum": 109.9737, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 358.05, "10th_percentile": 358.05, "90th_percentile": 358.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 174.6, "10th_percentile": 174.6, "90th_percentile": 174.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 310.59, "10th_percentile": 226.16, "90th_percentile": 320.17, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 378.84, "10th_percentile": 378.84, "90th_percentile": 378.84, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.2, "10th_percentile": 51.62, "90th_percentile": 157.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 98.16, "10th_percentile": 73.62, "90th_percentile": 98.16, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.42, "10th_percentile": 86.42, "90th_percentile": 115.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 439.9, "10th_percentile": 439.9, "90th_percentile": 439.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.2, "10th_percentile": 155.2, "90th_percentile": 155.2, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 9263.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9263.78 } ] } ] }, { "description": "Bill Prenatal Panel", "code_information": [ { "code": "80055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.5, "discounted_cash": 76.0, "minimum": 76.415, "maximum": 263.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 192.59, "10th_percentile": 192.59, "90th_percentile": 202.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 162.2, "10th_percentile": 162.2, "90th_percentile": 168.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 263.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 202.37, "10th_percentile": 202.37, "90th_percentile": 202.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 263.5, "10th_percentile": 248.5, "90th_percentile": 263.5, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 227.63, "10th_percentile": 227.63, "90th_percentile": 227.63, "count": "1 through 10" } ] } ] }, { "description": "OT Orthotic, Prosthetic Use, Check Out", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.75, "discounted_cash": 41.0, "minimum": 41.3975, "maximum": 129.4743, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Head w Contrast", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1872.25, "discounted_cash": 542.0, "minimum": 542.9525, "maximum": 1698.1308, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1113.65 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 890.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 837.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1766.25, "10th_percentile": 1766.25, "90th_percentile": 1766.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 599.12, "10th_percentile": 599.12, "90th_percentile": 599.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 565.2, "10th_percentile": 565.2, "90th_percentile": 565.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 599.12, "10th_percentile": 599.12, "90th_percentile": 599.12, "count": "1 through 10" } ] } ] }, { "description": "NM Salivary Gland Scan", "code_information": [ { "code": "78230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 757.75, "discounted_cash": 219.0, "minimum": 219.7475, "maximum": 757.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 532.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 652.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 521.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 757.75 } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 17853.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17853.23 } ] } ] }, { "description": "Clonazepam (Klonopin) Level - G0480 - 3358706", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.25, "minimum": 81.8525, "maximum": 382.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 344.75, "10th_percentile": 325.25, "90th_percentile": 344.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 282.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "XR Esophagram Dbl 74221", "code_information": [ { "code": "74221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 273.0, "minimum": 273.6875, "maximum": 855.9813, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 651.37 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 42654.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42654.89 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 38157.8296, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9639.48, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9749.6, "10th_percentile": 9749.6, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14025.35 } ] } ] }, { "description": "ABO Rh Type", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.25, "discounted_cash": 14.0, "minimum": 14.2825, "maximum": 44.6698, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 35.26, "10th_percentile": 35.26, "90th_percentile": 35.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.73, "10th_percentile": 17.73, "90th_percentile": 17.73, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.09, "10th_percentile": 17.09, "90th_percentile": 17.09, "count": "13" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 31.37, "10th_percentile": 31.37, "90th_percentile": 31.37, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.25, "10th_percentile": 49.25, "90th_percentile": 49.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 49.25, "10th_percentile": 49.25, "90th_percentile": 49.25, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 39.37, "10th_percentile": 15.76, "90th_percentile": 44.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 15.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 16.75, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.76, "10th_percentile": 15.76, "90th_percentile": 16.75, "count": "1 through 10" } ] } ] }, { "description": "PT Mechanical Traction Units", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.5, "discounted_cash": 27.0, "minimum": 27.695, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC", "code_information": [ { "code": "492", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 43284.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43284.42 } ] } ] }, { "description": "XR Mastoids Complete 3 Views Ea Side", "code_information": [ { "code": "70130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 407.0, "discounted_cash": 118.0, "minimum": 118.03, "maximum": 389.1278, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 389.13 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "357", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 27415.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27415.27 } ] } ] }, { "description": "IR Lymphangiogram Pelvic-Abd Uni LT 75805", "code_information": [ { "code": "75805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9735.25, "discounted_cash": 2823.0, "minimum": 948.13, "maximum": 8829.8718, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 967.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1185.17 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 948.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1821.55 } ] } ] }, { "description": "Vitamin B2 (Riboflavin) Level", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.5, "discounted_cash": 108.0, "minimum": 108.895, "maximum": 340.5785, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 204.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 163.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 375.5, "10th_percentile": 375.5, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.16, "10th_percentile": 120.16, "90th_percentile": 120.16, "count": "1 through 10" } ] } ] }, { "description": "%CDIFF Reflex Toxin", "code_information": [ { "code": "87803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 21.0, "minimum": 21.46, "maximum": 74.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.11, "10th_percentile": 25.11, "90th_percentile": 25.11, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.19, "10th_percentile": 24.19, "90th_percentile": 25.66, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.68, "10th_percentile": 23.68, "90th_percentile": 23.72, "count": "1 through 10" } ] } ] }, { "description": "US Pseudoaneurysm Compression", "code_information": [ { "code": "76936", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 555.5, "discounted_cash": 161.0, "minimum": 161.095, "maximum": 555.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 382.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 468.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 374.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.5 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 18294.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18294.14 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 25122.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25122.32 } ] } ] }, { "description": "TRAUMATIC INJURY WITH MCC", "code_information": [ { "code": "913", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 19270.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19270.27 } ] } ] }, { "description": "OT No Patient Present Trn Ea Add 15 Min Unit", "code_information": [ { "code": "G0542", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.25, "minimum": 39.2225, "maximum": 122.6718, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Estriol Level", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 287.5, "discounted_cash": 83.0, "minimum": 83.375, "maximum": 260.7625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.73 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 182.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 224.16 } ] } ] }, { "description": "CT Unlisted", "code_information": [ { "code": "76497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 268.0, "discounted_cash": 77.0, "minimum": 77.72, "maximum": 268.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.0 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 19839.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19839.67 } ] } ] }, { "description": "NM Thyroid Mets Image w Addl Study", "code_information": [ { "code": "78016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1218.75, "discounted_cash": 353.0, "minimum": 353.4375, "maximum": 1218.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.94 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1043.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 } ] } ] }, { "description": "Influenza A Ab, CSF", "code_information": [ { "code": "86710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.0, "discounted_cash": 69.0, "minimum": 69.02, "maximum": 215.866, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.62 } ] } ] }, { "description": "STRAPPING HAND FINGER FAC", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.75, "discounted_cash": 74.0, "minimum": 74.1675, "maximum": 231.9652, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 255.75, "10th_percentile": 255.75, "90th_percentile": 255.75, "count": "1 through 10" } ] } ] }, { "description": "SS PAS without Diastase 88313 AP Bill", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.25, "discounted_cash": 52.0, "minimum": 52.2725, "maximum": 180.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.25 } ] } ] }, { "description": "Continuous Nebulizer Treatment Subsequent", "code_information": [ { "code": "94645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.25, "discounted_cash": 125.0, "minimum": 125.3525, "maximum": 392.0507, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.25, "10th_percentile": 432.25, "90th_percentile": 432.25, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 500 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505615204", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "XR Wrist Left 3-4 Views", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 390.25, "discounted_cash": 113.0, "minimum": 97.22, "maximum": 353.9567, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 285.39, "10th_percentile": 285.39, "90th_percentile": 299.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.49, "10th_percentile": 132.57, "90th_percentile": 280.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.71, "10th_percentile": 127.71, "90th_percentile": 270.68, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 390.25, "10th_percentile": 390.25, "90th_percentile": 390.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 295.01, "10th_percentile": 295.01, "90th_percentile": 306.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.0, "10th_percentile": 124.88, "90th_percentile": 368.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 390.25, "10th_percentile": 368.25, "90th_percentile": 390.25, "count": "89" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 124.88, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 294.34, "10th_percentile": 117.84, "90th_percentile": 353.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 117.84, "90th_percentile": 151.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 117.84, "90th_percentile": 125.21, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 125.21, "count": "1 through 10" } ] } ] }, { "description": "Vanco", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 358.25, "discounted_cash": 103.0, "minimum": 103.8925, "maximum": 324.9327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.68, "10th_percentile": 121.68, "90th_percentile": 121.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 13.54, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 24786.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24786.33 } ] } ] }, { "description": "NM Liver+ Spleen Scan Static", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.25, "discounted_cash": 228.0, "minimum": 228.3025, "maximum": 787.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 631.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 774.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 619.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 787.25 } ] } ] }, { "description": "75860 FAC VENOGRAPHY VENOUS SINUS", "code_information": [ { "code": "75860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2078.0, "discounted_cash": 602.0, "minimum": 602.62, "maximum": 1884.746, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 859.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1052.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 842.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 29742.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29742.42 } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 23157.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23157.09 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "664", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12341.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12341.88 } ] } ] }, { "description": "ANKLE DISLOC NO ANES FAC", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.75, "discounted_cash": 102.0, "minimum": 102.8775, "maximum": 321.7582, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.56, "10th_percentile": 122.56, "90th_percentile": 122.56, "count": "1 through 10" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "417", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 28133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28133.22 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12497.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12497.5 } ] } ] }, { "description": "Magnesium, Blood Level", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 24.0, "minimum": 24.94, "maximum": 78.002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.58, "10th_percentile": 61.58, "90th_percentile": 61.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.96, "10th_percentile": 30.96, "90th_percentile": 30.96, "count": "23" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 54.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.82, "10th_percentile": 29.82, "90th_percentile": 29.82, "count": "46" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.89, "10th_percentile": 54.78, "90th_percentile": 70.52, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 68.89, "count": "20" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.0, "10th_percentile": 34.73, "90th_percentile": 86.0, "count": "30" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 19.99, "10th_percentile": 19.99, "90th_percentile": 19.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 86.0, "count": "278" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "128" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 31.82, "10th_percentile": 27.52, "90th_percentile": 78.0, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 27.52, "count": "72" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.2, "90th_percentile": 29.24, "count": "48" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.52, "10th_percentile": 27.52, "90th_percentile": 29.24, "count": "89" } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 10251.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10251.7 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "827", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 27246.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27246.69 } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 12951.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12951.37 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 19214.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19214.86 } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 13409.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13409.96 } ] } ] }, { "description": "Clozapine & Metabolites Quantitative", "code_information": [ { "code": "80159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.25, "discounted_cash": 24.0, "minimum": 24.7225, "maximum": 85.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.51, "10th_percentile": 32.48, "90th_percentile": 80.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 17.66, "10th_percentile": 17.66, "90th_percentile": 17.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 29.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.28, "10th_percentile": 25.76, "90th_percentile": 27.28, "count": "12" } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC", "code_information": [ { "code": "406", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 34190.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34190.4 } ] } ] }, { "description": "U Citrate, 24 Hour", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.0, "discounted_cash": 130.0, "minimum": 130.21, "maximum": 407.243, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 229.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 281.24 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 224.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 257.72 } ] } ] }, { "description": "Chromosome Analysis, Blood", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.0, "discounted_cash": 195.0, "minimum": 195.17, "maximum": 883.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 323.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.0 } ] } ] }, { "description": "VL Duplex Scan Abd Viscera Complete - Vascular US Charges", "code_information": [ { "code": "93975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1626.25, "discounted_cash": 471.0, "minimum": 471.6125, "maximum": 1475.0087, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 869.22, "10th_percentile": 869.22, "90th_percentile": 988.22, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 463.23, "10th_percentile": 463.23, "90th_percentile": 463.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 824.03, "10th_percentile": 673.04, "90th_percentile": 824.04, "count": "19" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 995.48, "10th_percentile": 995.48, "90th_percentile": 1030.69, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 826.66, "10th_percentile": 826.66, "90th_percentile": 1011.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 970.35, "10th_percentile": 970.35, "90th_percentile": 1028.5, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 412.76, "10th_percentile": 412.76, "90th_percentile": 412.76, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 940.85, "10th_percentile": 940.85, "90th_percentile": 940.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1286.75, "10th_percentile": 1214.0, "90th_percentile": 1286.75, "count": "38" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.76, "10th_percentile": 411.76, "90th_percentile": 411.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 411.76, "10th_percentile": 388.48, "90th_percentile": 1167.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.76, "10th_percentile": 411.76, "90th_percentile": 411.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.76, "10th_percentile": 411.76, "90th_percentile": 411.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.76, "10th_percentile": 411.76, "90th_percentile": 411.76, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 9272.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9272.03 } ] } ] }, { "description": "ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.5, "discounted_cash": 133.0, "minimum": 133.255, "maximum": 416.7665, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.42, "10th_percentile": 165.42, "90th_percentile": 165.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 318.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 390.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 312.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 358.03 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 459.5, "10th_percentile": 459.5, "90th_percentile": 459.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 416.77, "10th_percentile": 416.77, "90th_percentile": 416.77, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 62.42, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.04, "10th_percentile": 147.04, "90th_percentile": 147.04, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21520.0, "minimum": 21520.7, "maximum": 64720.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64720.32 } ] } ] }, { "description": "OTA MMT, Extremity, Trunk Units", "code_information": [ { "code": "95831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.5, "discounted_cash": 31.0, "minimum": 31.175, "maximum": 97.5025, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Cortisol", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.75, "discounted_cash": 51.0, "minimum": 51.8375, "maximum": 164.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.35, "10th_percentile": 64.35, "90th_percentile": 64.35, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 131.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.0, "10th_percentile": 62.0, "90th_percentile": 62.0, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.86, "10th_percentile": 113.86, "90th_percentile": 113.86, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 140.5, "10th_percentile": 140.5, "90th_percentile": 140.5, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 178.75, "10th_percentile": 178.75, "90th_percentile": 178.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 16.3, "90th_percentile": 60.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 162.13, "10th_percentile": 162.13, "90th_percentile": 162.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 66.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.2, "10th_percentile": 57.2, "90th_percentile": 57.2, "count": "1 through 10" } ] } ] }, { "description": "Mumps Antibody IgG", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.75, "discounted_cash": 23.0, "minimum": 23.4175, "maximum": 80.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.25, "10th_percentile": 76.25, "90th_percentile": 80.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.84, "10th_percentile": 24.4, "90th_percentile": 25.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.85, "10th_percentile": 69.85, "90th_percentile": 73.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.84, "10th_percentile": 25.84, "90th_percentile": 25.84, "count": "1 through 10" } ] } ] }, { "description": "Iron Level", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.5, "discounted_cash": 22.0, "minimum": 22.475, "maximum": 70.2925, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.49, "10th_percentile": 55.49, "90th_percentile": 55.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.9, "10th_percentile": 27.9, "90th_percentile": 27.9, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.88, "10th_percentile": 26.88, "90th_percentile": 26.88, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.37, "10th_percentile": 49.37, "90th_percentile": 49.37, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 62.09, "10th_percentile": 60.92, "90th_percentile": 62.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.5, "10th_percentile": 14.19, "90th_percentile": 77.5, "count": "21" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.01, "10th_percentile": 18.01, "90th_percentile": 59.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 77.5, "10th_percentile": 77.5, "90th_percentile": 77.5, "count": "123" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 22.48, "90th_percentile": 24.8, "count": "83" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 61.95, "10th_percentile": 24.8, "90th_percentile": 70.99, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 28.68, "count": "51" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 24.8, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.8, "10th_percentile": 24.8, "90th_percentile": 26.35, "count": "36" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "716", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 17341.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17341.59 } ] } ] }, { "description": "DNase B Antibody", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 48.0, "minimum": 48.72, "maximum": 152.376, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC", "code_information": [ { "code": "420", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 40166.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40166.23 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 17687.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17687.01 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "700", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8133.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8133.22 } ] } ] }, { "description": "LONG ARM SPLINT FAC", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 432.25, "discounted_cash": 125.0, "minimum": 125.3525, "maximum": 392.0507, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 346.23, "10th_percentile": 346.23, "90th_percentile": 346.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 411.75, "10th_percentile": 411.75, "90th_percentile": 432.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.32, "10th_percentile": 138.32, "90th_percentile": 138.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 377.16, "10th_percentile": 377.16, "90th_percentile": 377.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.32, "10th_percentile": 138.32, "90th_percentile": 138.32, "count": "1 through 10" } ] } ] }, { "description": "Bill IRL Cold Agg Titer", "code_information": [ { "code": "86157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.0, "discounted_cash": 68.0, "minimum": 65.22, "maximum": 214.052, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 66.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 81.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.72 } ] } ] }, { "description": "Entomoeba histolytica Antigen Stool, EIA", "code_information": [ { "code": "87337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.5, "discounted_cash": 45.0, "minimum": 45.965, "maximum": 143.7595, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" } ] } ] }, { "description": "SPLENIC PROCEDURES WITH MCC", "code_information": [ { "code": "799", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 53391.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53391.11 } ] } ] }, { "description": "PKU", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.0, "discounted_cash": 90.0, "minimum": 44.55, "maximum": 283.891, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 44.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.99 } ] } ] }, { "description": "GLUCOSE BLD MNTR DV FAC", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 8.0, "minimum": 8.7, "maximum": 30.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 18.95 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 30.0, "10th_percentile": 30.0, "90th_percentile": 30.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.28, "10th_percentile": 3.28, "90th_percentile": 3.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.1, "10th_percentile": 11.1, "90th_percentile": 11.1, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.6, "10th_percentile": 9.6, "90th_percentile": 9.6, "count": "1 through 10" } ] } ] }, { "description": "SHORT ARM SPLINT FAC", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.5, "discounted_cash": 82.0, "minimum": 82.795, "maximum": 258.9485, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 219.26, "10th_percentile": 219.26, "90th_percentile": 219.26, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 234.12, "10th_percentile": 234.12, "90th_percentile": 234.12, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 224.4, "10th_percentile": 224.4, "90th_percentile": 224.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 285.5, "10th_percentile": 272.0, "90th_percentile": 285.5, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.36, "10th_percentile": 91.36, "90th_percentile": 91.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 258.95, "10th_percentile": 258.95, "90th_percentile": 258.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.36, "10th_percentile": 91.36, "90th_percentile": 100.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.04, "10th_percentile": 87.04, "90th_percentile": 87.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.36, "10th_percentile": 91.36, "90th_percentile": 91.36, "count": "1 through 10" } ] } ] }, { "description": "HIV-1 RNA, QL TMA", "code_information": [ { "code": "87535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.0, "discounted_cash": 225.0, "minimum": 210.75, "maximum": 703.832, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 732.0, "10th_percentile": 732.0, "90th_percentile": 732.0, "count": "1 through 10" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 49367.718, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9786.03 } ] } ] }, { "description": "CT Thorax w Contrast", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2532.25, "discounted_cash": 734.0, "minimum": 650.0, "maximum": 2296.7508, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1710.52, "10th_percentile": 1710.52, "90th_percentile": 1710.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 860.04, "10th_percentile": 430.02, "90th_percentile": 911.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1105.43 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 878.19, "10th_percentile": 828.51, "90th_percentile": 878.19, "count": "24" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1990.35, "10th_percentile": 1626.76, "90th_percentile": 1990.35, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 986.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 725.32, "10th_percentile": 679.48, "90th_percentile": 812.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2532.25, "10th_percentile": 2389.0, "90th_percentile": 2532.25, "count": "41" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 812.26, "count": "72" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 2296.75, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 883.93, "count": "32" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 764.48, "90th_percentile": 812.26, "count": "27" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 810.32, "10th_percentile": 810.32, "90th_percentile": 812.26, "count": "22" } ] } ] }, { "description": "CA 19-9", "code_information": [ { "code": "86301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 32.0, "minimum": 32.19, "maximum": 111.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.52, "10th_percentile": 33.52, "90th_percentile": 35.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.52, "10th_percentile": 33.52, "90th_percentile": 33.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.52, "10th_percentile": 35.52, "90th_percentile": 35.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.62, "10th_percentile": 33.52, "90th_percentile": 35.62, "count": "1 through 10" } ] } ] }, { "description": "CT Core NDL BX Lng/Med Perq 32408", "code_information": [ { "code": "32408", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4568.75, "discounted_cash": 1324.0, "minimum": 650.0, "maximum": 4143.8562, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "U Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.0, "discounted_cash": 20.0, "minimum": 20.59, "maximum": 64.397, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 40.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.31 } ] } ] }, { "description": "SLP Non-Speech AAC Device Eval Units", "code_information": [ { "code": "92605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 148.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Potassium Chloride Inj 10 mEq/100ML", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338070948", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11561.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11561.45 } ] } ] }, { "description": "IR Adrenal Artery Scan Bilateral S+I", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 379.0, "minimum": 379.1025, "maximum": 1296.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1057.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1296.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1036.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.28 } ] } ] }, { "description": "PUNC ASP ABSCESS FAC", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.25, "discounted_cash": 95.0, "minimum": 95.1925, "maximum": 297.7228, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.38, "10th_percentile": 108.38, "90th_percentile": 108.38, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 328.25, "10th_percentile": 312.5, "90th_percentile": 328.25, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 19653.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19653.41 } ] } ] }, { "description": "CT Limited Follow-up", "code_information": [ { "code": "76380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 641.25, "discounted_cash": 185.0, "minimum": 185.9625, "maximum": 641.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 520.17 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 416.14 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 641.25 } ] } ] }, { "description": "Bone Iso", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.5, "discounted_cash": 72.0, "minimum": 72.065, "maximum": 225.3895, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 119.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 248.5, "10th_percentile": 248.5, "90th_percentile": 248.5, "count": "1 through 10" } ] } ] }, { "description": "BhCG Qual", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 27.0, "minimum": 27.405, "maximum": 85.7115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 67.66, "10th_percentile": 67.66, "90th_percentile": 67.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.69, "10th_percentile": 75.69, "90th_percentile": 77.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 74.28, "10th_percentile": 74.28, "90th_percentile": 74.28, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "60" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.71, "10th_percentile": 75.53, "90th_percentile": 86.56, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH CC", "code_information": [ { "code": "669", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 18296.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18296.5 } ] } ] }, { "description": "Hemoglobin A1C", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.5, "discounted_cash": 41.0, "minimum": 41.035, "maximum": 128.3405, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.31, "10th_percentile": 101.31, "90th_percentile": 101.31, "count": "29" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.94, "10th_percentile": 50.94, "90th_percentile": 50.94, "count": "114" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.52 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.07, "10th_percentile": 49.07, "90th_percentile": 49.07, "count": "118" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 90.14, "10th_percentile": 90.14, "90th_percentile": 90.14, "count": "53" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.22, "10th_percentile": 111.22, "90th_percentile": 113.36, "count": "55" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.38, "10th_percentile": 23.52, "90th_percentile": 141.5, "count": "202" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 32.89, "10th_percentile": 32.41, "90th_percentile": 109.66, "count": "11" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 141.5, "10th_percentile": 141.5, "90th_percentile": 141.5, "count": "431" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "329" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.36, "10th_percentile": 45.28, "90th_percentile": 129.61, "count": "121" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 45.28, "count": "237" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.11, "10th_percentile": 9.71, "90th_percentile": 48.11, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.28, "10th_percentile": 45.28, "90th_percentile": 48.11, "count": "152" } ] } ] }, { "description": "Gastroccult", "code_information": [ { "code": "82271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.5, "discounted_cash": 14.0, "minimum": 14.355, "maximum": 49.3191, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.32 } ] } ] }, { "description": "Drug Abuse Panel 12, Qualitative Urine", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "discounted_cash": 46.0, "minimum": 46.3275, "maximum": 158.8964, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 107.94, "10th_percentile": 107.94, "90th_percentile": 107.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.41, "10th_percentile": 55.41, "90th_percentile": 55.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.9 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 116.83, "10th_percentile": 116.83, "90th_percentile": 116.83, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 159.75, "10th_percentile": 150.75, "90th_percentile": 159.75, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.24, "10th_percentile": 48.24, "90th_percentile": 48.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.12, "10th_percentile": 51.12, "90th_percentile": 51.12, "count": "1 through 10" } ] } ] }, { "description": "Bill HLA Antibody Screen", "code_information": [ { "code": "86807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 463.0, "discounted_cash": 134.0, "minimum": 134.27, "maximum": 463.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 326.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.17 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 320.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 463.0 } ] } ] }, { "description": "Stool Culture with Gram Stain", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 58.0, "minimum": 58.9425, "maximum": 184.3477, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.38 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 76.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.5, "10th_percentile": 66.5, "90th_percentile": 70.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 153.61, "10th_percentile": 153.61, "90th_percentile": 153.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.51 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 148.61, "10th_percentile": 148.61, "90th_percentile": 148.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 203.25, "10th_percentile": 191.75, "90th_percentile": 203.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.36, "10th_percentile": 61.36, "90th_percentile": 65.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 65.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.04, "10th_percentile": 65.04, "90th_percentile": 65.04, "count": "1 through 10" } ] } ] }, { "description": "PLEURAL EFFUSION WITHOUT CCMCC", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8455.06 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 34731.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34731.51 } ] } ] }, { "description": "U Cadmium, 24HR", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 17.0, "minimum": 17.69, "maximum": 61.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6353.103, "maximum": 11030.95, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7933.54, "10th_percentile": 7933.54, "90th_percentile": 16153.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11030.95 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8115.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8115.53 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "747", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 10134.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10134.99 } ] } ] }, { "description": "OTA MMT, Hand Units", "code_information": [ { "code": "95832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.75, "discounted_cash": 30.0, "minimum": 30.0875, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC", "code_information": [ { "code": "558", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 10529.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10529.92 } ] } ] }, { "description": "US Fetal Biophys Prof wo Non-Stress", "code_information": [ { "code": "76819", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 180.0, "minimum": 180.96, "maximum": 565.968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 223.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 273.49 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 218.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 624.0, "10th_percentile": 624.0, "90th_percentile": 624.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 565.97, "10th_percentile": 565.97, "90th_percentile": 565.97, "count": "1 through 10" } ] } ] }, { "description": "NM Liver+ Spleen Scan w Flow", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.5, "discounted_cash": 179.0, "minimum": 179.655, "maximum": 619.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 440.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 539.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 431.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 619.5 } ] } ] }, { "description": "Protein S, Functional", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 496.5, "discounted_cash": 143.0, "minimum": 115.65, "maximum": 450.3255, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.02 } ] } ] }, { "description": "Gamma Glutamyl Transferase", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.75, "discounted_cash": 35.0, "minimum": 35.0175, "maximum": 109.5203, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 86.46, "10th_percentile": 86.46, "90th_percentile": 86.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.47, "10th_percentile": 43.47, "90th_percentile": 43.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 58.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.88, "10th_percentile": 41.88, "90th_percentile": 41.88, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 76.92, "10th_percentile": 76.92, "90th_percentile": 76.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.64, "10th_percentile": 38.64, "90th_percentile": 38.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.06, "10th_percentile": 41.06, "90th_percentile": 41.06, "count": "1 through 10" } ] } ] }, { "description": ".Anaplasma phagocytophilum (HGA) Ab, IgG", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.25, "discounted_cash": 50.0, "minimum": 50.5325, "maximum": 158.0447, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.37 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "328", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 18889.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18889.48 } ] } ] }, { "description": "NM Parathyroid Scan", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.75, "discounted_cash": 195.0, "minimum": 195.3875, "maximum": 673.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 519.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 636.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 509.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 673.75 } ] } ] }, { "description": "B-hCG Qualitative Screen, Urine", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.75, "discounted_cash": 22.0, "minimum": 22.2575, "maximum": 76.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 54.95, "10th_percentile": 54.95, "90th_percentile": 54.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.63, "10th_percentile": 13.86, "90th_percentile": 27.63, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 52.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 51.2 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.35, "10th_percentile": 13.35, "90th_percentile": 13.35, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 61.48, "10th_percentile": 61.48, "90th_percentile": 62.94, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 60.33, "10th_percentile": 60.33, "90th_percentile": 60.33, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 76.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.61, "10th_percentile": 8.61, "90th_percentile": 12.32, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 59.48, "10th_percentile": 59.48, "90th_percentile": 59.48, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.75, "10th_percentile": 38.5, "90th_percentile": 76.75, "count": "358" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.56, "10th_percentile": 8.61, "90th_percentile": 24.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 69.61, "10th_percentile": 24.56, "90th_percentile": 70.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.56, "10th_percentile": 24.56, "90th_percentile": 2322.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 24.56, "count": "1 through 10" } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11188.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11188.92 } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15692.0, "minimum": 15692.18, "maximum": 52820.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52820.52 } ] } ] }, { "description": "Hep C Viral RNA Ns5a Drug Resist", "code_information": [ { "code": "87902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2603.25, "discounted_cash": 754.0, "minimum": 665.66, "maximum": 2386.6902, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 665.66 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 1564.47, "10th_percentile": 1564.47, "90th_percentile": 1564.47, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2386.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1334.0, "10th_percentile": 1334.0, "90th_percentile": 2603.25, "count": "1 through 10" } ] } ] }, { "description": "CT Lumbar Spine wo Contrast", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1903.75, "discounted_cash": 552.0, "minimum": 552.0875, "maximum": 1726.7013, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1391.9, "10th_percentile": 1391.9, "90th_percentile": 1462.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 660.23, "10th_percentile": 622.85, "90th_percentile": 660.23, "count": "1 through 10" }, { "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": 724.71 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1903.75, "10th_percentile": 1796.0, "90th_percentile": 1903.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 574.72, "10th_percentile": 574.72, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 609.2, "10th_percentile": 609.2, "90th_percentile": 609.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 609.2, "10th_percentile": 574.72, "90th_percentile": 610.64, "count": "1 through 10" } ] } ] }, { "description": "Wheelchair Mgmt Training/15 min OT", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 26.0, "minimum": 26.3175, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "Calreticulin (CALR) Mutation Analysis", "code_information": [ { "code": "81219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1281.25, "discounted_cash": 371.0, "minimum": 371.5625, "maximum": 1162.0938, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 936.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1147.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 918.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1127.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 326.0, "10th_percentile": 326.0, "90th_percentile": 326.0, "count": "1 through 10" } ] } ] }, { "description": "$ Factor V Leiden", "code_information": [ { "code": "81241", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.75, "discounted_cash": 93.0, "minimum": 93.0175, "maximum": 320.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 292.72 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 286.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.24, "10th_percentile": 111.24, "90th_percentile": 111.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.75 } ] } ] }, { "description": "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC", "code_information": [ { "code": "629", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 25685.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25685.83 } ] } ] }, { "description": "MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES", "code_information": [ { "code": "483", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 32677.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32677.87 } ] } ] }, { "description": "PSYCHOSES", "code_information": [ { "code": "885", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14571.0, "minimum": 14571.31, "maximum": 16466.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16466.85 } ] } ] }, { "description": "Omalizumab Subcutaneous Soln Prefilled Syringe 75 MG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "50242021403", "type": "NDC" }, { "code": "J2357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 18206.35, "10th_percentile": 17413.05, "90th_percentile": 18206.35, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 19247.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19247.87 } ] } ] }, { "description": "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "622", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 41959.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41959.34 } ] } ] }, { "description": "NM Hida Scan w Function", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.0, "discounted_cash": 378.0, "minimum": 378.45, "maximum": 1305.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1186.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1163.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 } ] } ] }, { "description": "Platelet", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 17.0, "minimum": 17.69, "maximum": 55.327, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 36.19 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.15, "10th_percentile": 21.15, "90th_percentile": 21.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 61.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.4, "10th_percentile": 4.48, "90th_percentile": 19.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 19.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.52, "10th_percentile": 19.52, "90th_percentile": 19.52, "count": "1 through 10" } ] } ] }, { "description": "XR Skull 1-3 Views", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.5, "discounted_cash": 113.0, "minimum": 94.37, "maximum": 355.9975, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 370.25, "10th_percentile": 370.25, "90th_percentile": 370.25, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 21184.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21184.8 } ] } ] }, { "description": "Presence of Sperm Post Vasectomy", "code_information": [ { "code": "89321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 22.0, "minimum": 22.8375, "maximum": 78.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.75 } ] } ] }, { "description": "Mononucleosis Screen", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.75, "discounted_cash": 27.0, "minimum": 27.4775, "maximum": 85.9382, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 69.36, "10th_percentile": 69.36, "90th_percentile": 69.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.89, "10th_percentile": 75.89, "90th_percentile": 77.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.75, "10th_percentile": 89.5, "90th_percentile": 94.75, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.32, "10th_percentile": 30.32, "90th_percentile": 30.32, "count": "1 through 10" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 26086.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26086.65 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 37847.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37847.34 } ] } ] }, { "description": "XR UGI Single 74240", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1085.75, "discounted_cash": 314.0, "minimum": 281.72, "maximum": 984.7753, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 287.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 352.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 281.72 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 719.05 } ] } ] }, { "description": "XR Wrist Right AP+Lateral", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.5, "discounted_cash": 100.0, "minimum": 77.24, "maximum": 315.1825, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 347.5, "10th_percentile": 327.75, "90th_percentile": 347.5, "count": "1 through 10" } ] } ] }, { "description": "EVAC SUBUNGUAL HEMAT FAC", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.0, "discounted_cash": 47.0, "minimum": 47.56, "maximum": 148.748, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.0, "10th_percentile": 50.0, "90th_percentile": 50.0, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "422", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 16498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16498.68 } ] } ] }, { "description": "TPMT Enzyme, Prometheus", "code_information": [ { "code": "82657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.5, "discounted_cash": 88.0, "minimum": 88.305, "maximum": 276.1815, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.53 } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19054.0, "minimum": 19054.79, "maximum": 66072.52, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66072.52 } ] } ] }, { "description": "zzssDNA Antibody, IgG", "code_information": [ { "code": "86226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 44.0, "minimum": 44.2975, "maximum": 138.5443, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.27 } ] } ] }, { "description": "Histoplasma Ab by ID", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 31.0, "minimum": 31.61, "maximum": 109.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 101.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.0 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 20825.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20825.23 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11291.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11291.49 } ] } ] }, { "description": "Hepatitis B Surface Antibody", "code_information": [ { "code": "86706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 31.0, "minimum": 31.6825, "maximum": 105.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 73.75, "10th_percentile": 73.75, "90th_percentile": 73.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 69.59, "10th_percentile": 69.59, "90th_percentile": 69.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 82.51, "10th_percentile": 82.51, "90th_percentile": 82.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 109.25, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 99.09, "90th_percentile": 99.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 32.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "description": "Specific Gravity, Urine", "code_information": [ { "code": "81002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 15.0, "minimum": 15.95, "maximum": 49.885, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.98, "10th_percentile": 10.98, "90th_percentile": 10.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 20.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.58, "10th_percentile": 10.58, "90th_percentile": 10.58, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.48, "10th_percentile": 3.48, "90th_percentile": 9.76, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 30.5, "10th_percentile": 30.5, "90th_percentile": 30.5, "count": "98" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 3.48, "90th_percentile": 9.76, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 9.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 11.29, "count": "24" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.76, "10th_percentile": 9.76, "90th_percentile": 10.37, "count": "18" } ] } ] }, { "description": "Manganese Level, Serum", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.25, "discounted_cash": 76.0, "minimum": 76.6325, "maximum": 248.68, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 202.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 248.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 198.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 264.25, "10th_percentile": 264.25, "90th_percentile": 264.25, "count": "1 through 10" } ] } ] }, { "description": "Diphenhydramine HCl Inj 50 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323066400", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "33" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CCMCC", "code_information": [ { "code": "482", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 19227.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19227.83 } ] } ] }, { "description": "ChrA BM", "code_information": [ { "code": "88237", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 673.0, "discounted_cash": 195.0, "minimum": 195.17, "maximum": 883.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 329.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 404.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 323.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 673.0 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 12615.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12615.39 } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8901.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8901.86 } ] } ] }, { "description": "% CD3", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.25, "discounted_cash": 30.0, "minimum": 30.8125, "maximum": 106.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 83.51, "10th_percentile": 83.51, "90th_percentile": 83.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.25 } ] } ] }, { "description": "VAGINA, CERVIX AND VULVA PROCEDURES WITH CCMCC", "code_information": [ { "code": "746", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 20478.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20478.64 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC", "code_information": [ { "code": "625", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 35603.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35603.9 } ] } ] }, { "description": ".stratify JCV Ab Inhibition", "code_information": [ { "code": "86711", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1712.75, "discounted_cash": 496.0, "minimum": 109.67, "maximum": 1553.4642, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.09 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 109.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.58 } ] } ] }, { "description": "MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 35758.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35758.33 } ] } ] }, { "description": "CT CCTA w+wo Disease Strxr", "code_information": [ { "code": "75573", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1451.25, "discounted_cash": 420.0, "minimum": 420.8625, "maximum": 1451.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1247.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 998.17 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1451.25 } ] } ] }, { "description": "REM FB EYE SUPERFIC FAC", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.0, "discounted_cash": 92.0, "minimum": 92.51, "maximum": 289.333, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 319.0, "10th_percentile": 319.0, "90th_percentile": 319.0, "count": "1 through 10" } ] } ] }, { "description": "PT Neuromuscular Reeducation Units", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 34.0, "minimum": 34.22, "maximum": 107.026, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC", "code_information": [ { "code": "495", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 42743.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42743.3 } ] } ] }, { "description": "HSV I/II Ab Screen, IgG", "code_information": [ { "code": "86694", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.0, "discounted_cash": 49.0, "minimum": 49.01, "maximum": 153.283, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 129.79, "10th_percentile": 129.79, "90th_percentile": 129.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 169.0, "10th_percentile": 159.5, "90th_percentile": 169.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 153.28, "10th_percentile": 153.28, "90th_percentile": 153.28, "count": "1 through 10" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "857", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 25246.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25246.1 } ] } ] }, { "description": "IH PIN4 Multiplex 88344 Bill", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.5, "discounted_cash": 63.0, "minimum": 63.365, "maximum": 218.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.5 } ] } ] }, { "description": "Sirolimus (Rapamycin) Level", "code_information": [ { "code": "80195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.25, "discounted_cash": 41.0, "minimum": 41.2525, "maximum": 129.0207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 60.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 58.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC", "code_information": [ { "code": "868", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 19272.537, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6167.61, "10th_percentile": 6167.61, "90th_percentile": 26379.21, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12155.62 } ] } ] }, { "description": "IRRIGATION OF BLADDER FAC", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 893.25, "discounted_cash": 259.0, "minimum": 259.0425, "maximum": 810.1777, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 272.24, "10th_percentile": 272.24, "90th_percentile": 272.24, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 51015.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51015.63 } ] } ] }, { "description": "Varicella Ab, IgG", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.75, "discounted_cash": 44.0, "minimum": 44.2975, "maximum": 138.5443, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 144.0, "10th_percentile": 144.0, "90th_percentile": 152.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 48.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 131.9, "10th_percentile": 131.9, "90th_percentile": 138.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.4 } ] } ] }, { "description": "OT Work Hardening-Each Addl Hour Units", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 71.0, "minimum": 71.05, "maximum": 222.215, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "NM Bone Scan Multiple", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.5, "discounted_cash": 202.0, "minimum": 202.855, "maximum": 699.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 699.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 699.5 } ] } ] }, { "description": "Blood Type Rh", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.25, "discounted_cash": 13.0, "minimum": 13.4125, "maximum": 41.9487, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 33.12, "10th_percentile": 33.12, "90th_percentile": 33.12, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.65, "10th_percentile": 16.65, "90th_percentile": 16.65, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.13 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 24.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.04, "10th_percentile": 16.04, "90th_percentile": 16.04, "count": "13" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 29.46, "10th_percentile": 29.46, "90th_percentile": 29.46, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.25, "10th_percentile": 46.25, "90th_percentile": 46.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 46.25, "10th_percentile": 46.25, "90th_percentile": 46.25, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 36.97, "10th_percentile": 14.8, "90th_percentile": 41.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 14.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 15.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.8, "10th_percentile": 14.8, "90th_percentile": 15.73, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "825", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 15908.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15908.05 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 19128.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19128.8 } ] } ] }, { "description": "US Echo Encephalogram", "code_information": [ { "code": "76506", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.25, "discounted_cash": 148.0, "minimum": 148.8425, "maximum": 513.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 513.25 } ] } ] }, { "description": "NM Brain Imaging Complete w Vasc Flow", "code_information": [ { "code": "78606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 406.0, "minimum": 406.5075, "maximum": 1401.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1066.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1306.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1045.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH MCC", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 20819.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20819.34 } ] } ] }, { "description": "MRI Toes Left 73721", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2306.0, "discounted_cash": 668.0, "minimum": 668.74, "maximum": 2091.542, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1639.49, "10th_percentile": 1639.49, "90th_percentile": 1639.49, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 691.83, "10th_percentile": 691.83, "90th_percentile": 768.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 666.47, "10th_percentile": 666.47, "90th_percentile": 666.47, "count": "1 through 10" }, { "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": 1223.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2134.75, "10th_percentile": 1921.75, "90th_percentile": 2134.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 614.96, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" } ] } ] }, { "description": "Calcitonin Level", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 754.75, "discounted_cash": 218.0, "minimum": 216.68, "maximum": 684.5583, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 221.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 270.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 216.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.36 } ] } ] }, { "description": "Gram positive identification (Vitek)", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 23.0, "minimum": 23.635, "maximum": 74.9056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.13, "10th_percentile": 55.13, "90th_percentile": 59.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.34, "10th_percentile": 29.34, "90th_percentile": 29.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.26, "10th_percentile": 26.7, "90th_percentile": 56.53, "count": "18" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 51.92, "10th_percentile": 51.92, "90th_percentile": 51.92, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 61.68, "10th_percentile": 61.68, "90th_percentile": 64.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 74.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.2, "10th_percentile": 8.08, "90th_percentile": 81.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.94, "10th_percentile": 18.94, "90th_percentile": 18.94, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.5, "10th_percentile": 77.0, "90th_percentile": 81.5, "count": "65" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 8.08, "90th_percentile": 52.16, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.49, "10th_percentile": 24.64, "90th_percentile": 221.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 52.16, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.16, "10th_percentile": 26.08, "90th_percentile": 78.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.08, "10th_percentile": 24.64, "90th_percentile": 49.28, "count": "17" } ] } ] }, { "description": "Hepatitis B DNA Quant. RT-PCR", "code_information": [ { "code": "87517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 645.25, "discounted_cash": 187.0, "minimum": 187.1225, "maximum": 585.2418, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 608.75, "10th_percentile": 608.75, "90th_percentile": 645.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 585.24, "10th_percentile": 585.24, "90th_percentile": 585.24, "count": "1 through 10" } ] } ] }, { "description": "Homocysteine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.0, "discounted_cash": 75.0, "minimum": 75.69, "maximum": 236.727, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.51, "10th_percentile": 90.51, "90th_percentile": 90.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.13 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 261.0, "10th_percentile": 261.0, "90th_percentile": 261.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.52, "10th_percentile": 83.52, "90th_percentile": 83.52, "count": "1 through 10" } ] } ] }, { "description": "Anti-Xa Level LMW Heparin", "code_information": [ { "code": "85520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.75, "discounted_cash": 55.0, "minimum": 55.0275, "maximum": 172.1033, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 105.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.35 } ] } ] }, { "description": "NM GI Bleed Localization", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 233.0, "minimum": 233.015, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH MCC", "code_information": [ { "code": "466", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 61366.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61366.36 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 13378.5366, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 5755.14, "10th_percentile": 5755.14, "90th_percentile": 5755.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13058.65 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 19917.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19917.48 } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 31942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31942.24 } ] } ] }, { "description": "Amino Acids, Urine", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1388.0, "discounted_cash": 402.0, "minimum": 86.5, "maximum": 1258.916, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 86.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.39 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 28260.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28260.54 } ] } ] }, { "description": "Saccharomyces cerevisiae IgA", "code_information": [ { "code": "86671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 42.0, "minimum": 42.63, "maximum": 133.329, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.56 } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [ { "code": "728", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9563.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9563.22 } ] } ] }, { "description": "88331 AP Bill Frozen single specimen", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.75, "discounted_cash": 113.0, "minimum": 113.8975, "maximum": 392.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.75 } ] } ] }, { "description": "CRP (C-Reactive Protein)", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.25, "discounted_cash": 34.0, "minimum": 34.2925, "maximum": 107.2528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 79.83, "10th_percentile": 79.83, "90th_percentile": 79.83, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.14, "10th_percentile": 40.14, "90th_percentile": 42.57, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.01, "10th_percentile": 38.67, "90th_percentile": 41.01, "count": "43" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.33, "10th_percentile": 75.33, "90th_percentile": 75.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 89.32, "10th_percentile": 89.32, "90th_percentile": 92.94, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.5, "10th_percentile": 42.48, "90th_percentile": 118.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 86.41, "10th_percentile": 27.49, "90th_percentile": 90.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 118.25, "10th_percentile": 111.5, "90th_percentile": 118.25, "count": "150" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "75" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 41.26, "10th_percentile": 37.84, "90th_percentile": 107.25, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.84, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.91, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 35.68, "90th_percentile": 37.91, "count": "35" } ] } ] }, { "description": "CBC", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 23.0, "minimum": 23.925, "maximum": 74.8275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 55.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 29.7, "count": "33" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.61, "10th_percentile": 26.97, "90th_percentile": 28.61, "count": "52" }, { "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": 63.75, "count": "21" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.5, "10th_percentile": 5.32, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 19.18, "10th_percentile": 17.81, "90th_percentile": 19.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "243" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.88, "10th_percentile": 6.47, "90th_percentile": 26.4, "count": "143" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.77, "10th_percentile": 24.88, "90th_percentile": 74.83, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "34" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "62" } ] } ] }, { "description": "US LT Ext Msk COMP 78803", "code_information": [ { "code": "76883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4697.75, "discounted_cash": 1362.0, "minimum": 121.2183, "maximum": 4260.8593, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.22 } ] } ] }, { "description": "XR Salivary Gland", "code_information": [ { "code": "70380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 733.5, "discounted_cash": 212.0, "minimum": 110.11, "maximum": 665.2845, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 } ] } ] }, { "description": "MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC", "code_information": [ { "code": "809", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 52483.617, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25725.84, "10th_percentile": 25725.84, "90th_percentile": 25725.84, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14923.67 } ] } ] }, { "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": 157.0, "minimum": 157.2525, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 320.34 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 511.5, "10th_percentile": 511.5, "90th_percentile": 511.5, "count": "1 through 10" } ] } ] }, { "description": "Dopamine Level", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.75, "discounted_cash": 72.0, "minimum": 72.7175, "maximum": 250.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 250.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 204.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.08 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 311.0, "10th_percentile": 311.0, "90th_percentile": 311.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.24, "10th_percentile": 80.24, "90th_percentile": 99.52, "count": "1 through 10" } ] } ] }, { "description": "ATHRO ASP/INJ W US GUID BURS FAC", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2497.25, "discounted_cash": 724.0, "minimum": 724.2025, "maximum": 2265.0057, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2265.01, "10th_percentile": 2265.01, "90th_percentile": 2265.01, "count": "1 through 10" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 16098.345, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10104.33 } ] } ] }, { "description": "C1Q Binding Assay", "code_information": [ { "code": "86332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.75, "discounted_cash": 80.0, "minimum": 80.5475, "maximum": 251.9193, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 201.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 246.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 197.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.92 } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 27612.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27612.15 } ] } ] }, { "description": "OT Re-Eval Est Plan Care", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.25, "discounted_cash": 82.0, "minimum": 82.1425, "maximum": 256.9078, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MRI Brain w+wo Contrast", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2514.75, "discounted_cash": 729.0, "minimum": 729.2775, "maximum": 2514.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1800.56, "10th_percentile": 1800.56, "90th_percentile": 1800.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 905.31, "10th_percentile": 905.31, "90th_percentile": 905.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2514.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 872.12, "10th_percentile": 872.12, "90th_percentile": 872.12, "count": "1 through 10" }, { "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": 1863.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 884.72, "10th_percentile": 864.72, "90th_percentile": 2164.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 544.85, "10th_percentile": 544.85, "90th_percentile": 544.85, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2514.75, "10th_percentile": 2514.75, "90th_percentile": 2514.75, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 804.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 804.72, "10th_percentile": 804.72, "90th_percentile": 855.02, "count": "1 through 10" } ] } ] }, { "description": "SLP Use,Fit Speech Prosthetic Eval Units", "code_information": [ { "code": "92597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.0, "discounted_cash": 101.0, "minimum": 95.0, "maximum": 318.357, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Angio Abd Pelvis", "code_information": [ { "code": "74174", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2512.0, "discounted_cash": 728.0, "minimum": 650.0, "maximum": 2436.3171, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1836.56, "10th_percentile": 1836.56, "90th_percentile": 1836.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 853.11, "10th_percentile": 853.11, "90th_percentile": 904.32, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2263.98 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1811.18 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.16, "10th_percentile": 821.83, "90th_percentile": 871.16, "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": 78.6, "median_amount": 1898.41, "10th_percentile": 1898.41, "90th_percentile": 1898.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2436.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1215.56, "10th_percentile": 1215.56, "90th_percentile": 1215.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2512.0, "10th_percentile": 2512.0, "90th_percentile": 2512.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 777.02, "10th_percentile": 777.02, "90th_percentile": 777.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 803.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 805.72, "10th_percentile": 805.72, "90th_percentile": 805.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 758.32, "10th_percentile": 758.32, "90th_percentile": 805.72, "count": "1 through 10" } ] } ] }, { "description": "Legionella Ab", "code_information": [ { "code": "86713", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 71.0, "minimum": 71.195, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 126.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 154.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 123.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.84 } ] } ] }, { "description": "MRI Pelvis w+wo Contrast", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3269.0, "discounted_cash": 948.0, "minimum": 900.0, "maximum": 2964.983, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2061.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 3269.0, "10th_percentile": 3269.0, "90th_percentile": 3269.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2994.4, "10th_percentile": 2994.4, "90th_percentile": 2994.4, "count": "1 through 10" } ] } ] }, { "description": "SHBG (Sex Hormone Binding Globulin)", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.5, "discounted_cash": 32.0, "minimum": 32.045, "maximum": 110.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 169.73, "10th_percentile": 169.73, "90th_percentile": 169.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 88.52, "10th_percentile": 88.52, "90th_percentile": 88.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "25" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 37.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 100.22, "10th_percentile": 35.36, "90th_percentile": 101.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 40.89, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.36, "10th_percentile": 35.36, "90th_percentile": 35.36, "count": "1 through 10" } ] } ] }, { "description": "88160 AP Bill Non-Gyn Cytology", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.75, "discounted_cash": 39.0, "minimum": 39.9475, "maximum": 137.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.75 } ] } ] }, { "description": "IM Hormonal Antineoplastic", "code_information": [ { "code": "96402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 121.0, "minimum": 121.4375, "maximum": 379.8062, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 285.51, "10th_percentile": 285.51, "90th_percentile": 285.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 150.75, "10th_percentile": 150.75, "90th_percentile": 150.75, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 260.26, "10th_percentile": 214.53, "90th_percentile": 268.17, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.29, "10th_percentile": 138.29, "90th_percentile": 138.29, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.75, "10th_percentile": 398.75, "90th_percentile": 418.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 268.0, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 134.0, "90th_percentile": 268.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 134.0, "90th_percentile": 268.0, "count": "1 through 10" } ] } ] }, { "description": "Semen Analysis, Post Procedure", "code_information": [ { "code": "89310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.0, "discounted_cash": 36.0, "minimum": 36.54, "maximum": 114.282, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 69.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.82 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 18422.64, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2241.74, "10th_percentile": 2241.74, "90th_percentile": 2241.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18422.64 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 5327.5639, "maximum": 12095.49, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12095.49 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "818", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 13665.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13665.79 } ] } ] }, { "description": "Collection Capillary Blood Specimen", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.25, "discounted_cash": 5.0, "minimum": 5.5825, "maximum": 17.4597, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.95, "10th_percentile": 5.6, "90th_percentile": 6.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 93.6, "10th_percentile": 7.12, "90th_percentile": 107.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.6, "10th_percentile": 7.12, "90th_percentile": 126.7, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 6.16, "10th_percentile": 5.6, "90th_percentile": 6.16, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITH MCC", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 52835.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52835.85 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "750", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 17398.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17398.18 } ] } ] }, { "description": "SIM REP TRK 2.6-7.5C FAC", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 115.0, "minimum": 115.42, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 143.28, "10th_percentile": 143.28, "90th_percentile": 143.28, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 326.36, "10th_percentile": 326.35, "90th_percentile": 326.36, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 209.72, "10th_percentile": 209.72, "90th_percentile": 209.72, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 155.15, "10th_percentile": 155.15, "90th_percentile": 155.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.0, "10th_percentile": 379.0, "90th_percentile": 398.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 121.28, "90th_percentile": 128.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 347.16, "10th_percentile": 347.16, "90th_percentile": 360.99, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 121.28, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" } ] } ] }, { "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": 76.8, "median_amount": 4081.54, "10th_percentile": 4081.54, "90th_percentile": 4081.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 225.67, "10th_percentile": 225.67, "90th_percentile": 2654.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4235.75, "10th_percentile": 4235.75, "90th_percentile": 4235.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 456.56, "10th_percentile": 456.56, "90th_percentile": 485.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1099.2, "10th_percentile": 377.16, "90th_percentile": 3724.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 381.25, "10th_percentile": 381.25, "90th_percentile": 381.25, "count": "1 through 10" } ] } ] }, { "description": "XR Lumbar Sp w Bending Min 6V", "code_information": [ { "code": "72114", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.25, "discounted_cash": 228.0, "minimum": 203.05, "maximum": 714.0358, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.39, "10th_percentile": 267.39, "90th_percentile": 267.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 207.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 203.05 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.02, "10th_percentile": 273.02, "90th_percentile": 273.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.6 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 742.75, "10th_percentile": 742.75, "90th_percentile": 742.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.68, "10th_percentile": 237.68, "90th_percentile": 237.68, "count": "1 through 10" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18559.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18559.39 } ] } ] }, { "description": "Legionella Ag, Urine", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.25, "discounted_cash": 85.0, "minimum": 85.6225, "maximum": 267.7917, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 15936.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15936.34 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 11881.22, "maximum": 44058.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44058.95 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 22847.5885, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2657.57, "10th_percentile": 2657.57, "90th_percentile": 2657.57, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7262.12, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12770.73, "10th_percentile": 4602.19, "90th_percentile": 100307.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 6949.39, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2240.0, "10th_percentile": 2240.0, "90th_percentile": 2240.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10267.02 } ] } ] }, { "description": "IR Adrenal Artery Scan Unilateral S+I", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 379.0, "minimum": 379.1025, "maximum": 1185.6758, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 943.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1156.58 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 925.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 845.93 } ] } ] }, { "description": "NM Lung Quant Vent w Perf", "code_information": [ { "code": "78598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1114.25, "discounted_cash": 323.0, "minimum": 323.1325, "maximum": 1114.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1064.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1114.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1043.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1114.25 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12773.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12773.36 } ] } ] }, { "description": "Holter Monitor Acquistion", "code_information": [ { "code": "93226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.0, "discounted_cash": 142.0, "minimum": 142.97, "maximum": 447.151, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 375.27, "10th_percentile": 375.27, "90th_percentile": 375.27, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 16455.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16455.06 } ] } ] }, { "description": "U Cortisol, Random", "code_information": [ { "code": "82530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 16.0, "minimum": 16.095, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "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": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.71, "10th_percentile": 16.71, "90th_percentile": 16.71, "count": "1 through 10" } ] } ] }, { "description": "XR Sacroiliac Joints 1-2 Views", "code_information": [ { "code": "72200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.25, "discounted_cash": 127.0, "minimum": 78.67, "maximum": 398.3997, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.3 } ] } ] }, { "description": "NM First Pass Single", "code_information": [ { "code": "78481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.5, "discounted_cash": 97.0, "minimum": 97.295, "maximum": 335.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 335.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.5 } ] } ] }, { "description": "NONTRAUMATIC STUPOR AND COMA WITH MCC", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 21338.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21338.05 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9827.622, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7568.53 } ] } ] }, { "description": "Phonophoresis/15M OPRS OT", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 27.0, "minimum": 27.26, "maximum": 94.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.0 } ] } ] }, { "description": "NON-EXTENSIVE BURNS", "code_information": [ { "code": "935", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 24285.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24285.3 } ] } ] }, { "description": "RHIG - 90384 - 3001009", "code_information": [ { "code": "90384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.25, "discounted_cash": 118.0, "minimum": 118.9725, "maximum": 410.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 389.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 311.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 266.14 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 114.63, "10th_percentile": 114.63, "90th_percentile": 114.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 372.1, "10th_percentile": 372.1, "90th_percentile": 372.1, "count": "1 through 10" } ] } ] }, { "description": "Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.25, "discounted_cash": 30.0, "minimum": 30.2325, "maximum": 104.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.25, "10th_percentile": 104.25, "90th_percentile": 104.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 104.25, "10th_percentile": 104.25, "90th_percentile": 104.25, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.45, "10th_percentile": 35.45, "90th_percentile": 35.45, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.45, "10th_percentile": 33.36, "90th_percentile": 35.45, "count": "1 through 10" } ] } ] }, { "description": "Cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 13.0, "minimum": 13.92, "maximum": 44.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 34.37, "10th_percentile": 34.37, "90th_percentile": 34.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 35.24 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.65, "10th_percentile": 16.65, "90th_percentile": 16.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 30.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.87, "10th_percentile": 14.87, "90th_percentile": 14.87, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.35, "10th_percentile": 4.35, "90th_percentile": 4.35, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 43.97, "10th_percentile": 43.54, "90th_percentile": 43.97, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "1 through 10" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITH MCC", "code_information": [ { "code": "668", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 34423.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34423.82 } ] } ] }, { "description": "CD4/CD8 Ratio", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.75, "discounted_cash": 37.0, "minimum": 37.3375, "maximum": 128.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 101.2, "10th_percentile": 101.2, "90th_percentile": 101.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.75 } ] } ] }, { "description": "PENIS PROCEDURES WITH CCMCC", "code_information": [ { "code": "709", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 27434.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27434.14 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "965", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 11087.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11087.54 } ] } ] }, { "description": "XR Shoulder Left Complete", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 430.0, "discounted_cash": 124.0, "minimum": 80.1, "maximum": 390.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 290.52, "10th_percentile": 290.52, "90th_percentile": 290.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.8, "10th_percentile": 146.07, "90th_percentile": 154.8, "count": "13" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 149.12, "10th_percentile": 140.72, "90th_percentile": 149.12, "count": "12" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 273.91, "10th_percentile": 258.46, "90th_percentile": 344.43, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 325.05, "10th_percentile": 325.05, "90th_percentile": 325.05, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.96, "10th_percentile": 137.6, "90th_percentile": 275.2, "count": "15" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 430.0, "10th_percentile": 405.75, "90th_percentile": 430.0, "count": "69" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 390.01, "10th_percentile": 137.6, "90th_percentile": 390.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 150.13, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.6, "10th_percentile": 129.84, "90th_percentile": 137.96, "count": "12" } ] } ] }, { "description": "CPR FAC", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1171.5, "discounted_cash": 339.0, "minimum": 339.735, "maximum": 1062.5505, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 374.88, "10th_percentile": 374.88, "90th_percentile": 374.88, "count": "1 through 10" } ] } ] }, { "description": "XR Ribs Bilateral w PA Chest", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.25, "discounted_cash": 192.0, "minimum": 141.59, "maximum": 600.6608, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 141.59 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.67, "10th_percentile": 229.67, "90th_percentile": 229.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 315.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.92, "10th_percentile": 211.92, "90th_percentile": 211.92, "count": "1 through 10" } ] } ] }, { "description": "RENAL FAILURE WITH CC", "code_information": [ { "code": "683", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 4451.0958, "maximum": 10324.79, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7027.86, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6801.9, "10th_percentile": 6801.9, "90th_percentile": 6801.9, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10324.79 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH MCC", "code_information": [ { "code": "907", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15243.0, "minimum": 15243.83, "maximum": 45261.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45261.43 } ] } ] }, { "description": "Ophth Ultrasound B W/Non Quant A", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 157.0, "minimum": 152.2912, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.29 } ] } ] }, { "description": "Calprotectin, Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370.0, "discounted_cash": 107.0, "minimum": 107.3, "maximum": 335.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 264.92, "10th_percentile": 264.92, "90th_percentile": 264.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.2, "10th_percentile": 133.2, "90th_percentile": 133.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 162.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 158.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.32, "10th_percentile": 128.32, "90th_percentile": 128.32, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 235.69, "10th_percentile": 235.69, "90th_percentile": 235.69, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 296.41, "10th_percentile": 296.41, "90th_percentile": 296.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.98 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 370.0, "10th_percentile": 370.0, "90th_percentile": 370.0, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 19.63, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 335.59, "10th_percentile": 335.59, "90th_percentile": 335.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 19.63, "90th_percentile": 125.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.4, "10th_percentile": 118.4, "90th_percentile": 118.4, "count": "1 through 10" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "855", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17650.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17650.46 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC", "code_information": [ { "code": "435", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 30491.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.82 } ] } ] }, { "description": "Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.0, "discounted_cash": 97.0, "minimum": 97.73, "maximum": 305.659, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 236.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 305.66, "10th_percentile": 305.66, "90th_percentile": 305.66, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 14650.3735, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 5388.03, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4102.56, "10th_percentile": 4102.56, "90th_percentile": 4102.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5156.0, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8960.0, "10th_percentile": 8960.0, "90th_percentile": 8960.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8673.15 } ] } ] }, { "description": "CT Lumbar Spine w Contrast", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2085.75, "discounted_cash": 604.0, "minimum": 604.8675, "maximum": 1891.7752, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1381.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1105.43 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 984.09 } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 23132.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23132.34 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19503.0, "minimum": 19503.14, "maximum": 42579.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42579.44 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 16549.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16549.37 } ] } ] }, { "description": "Phencyclidine (PCP), Urine Quantitative", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.0, "discounted_cash": 46.0, "minimum": 46.4, "maximum": 155.7444, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.65 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 118.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 } ] } ] }, { "description": "Bill IRL Dif Aut Adsorp Ea", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 33.0, "minimum": 33.64, "maximum": 116.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 } ] } ] }, { "description": "Echo 2-D Limited F/U w/Contrast - 93308 - 5001003", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1496.75, "discounted_cash": 434.0, "minimum": 434.0575, "maximum": 1357.5522, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1159.98, "10th_percentile": 1159.98, "90th_percentile": 1159.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 958.52, "10th_percentile": 958.52, "90th_percentile": 976.93, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 519.08, "10th_percentile": 519.08, "90th_percentile": 519.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1196.35, "10th_percentile": 1196.35, "90th_percentile": 1196.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1496.75, "10th_percentile": 1496.75, "90th_percentile": 1496.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 478.96, "10th_percentile": 478.96, "90th_percentile": 508.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.76, "10th_percentile": 110.76, "90th_percentile": 478.96, "count": "1 through 10" } ] } ] }, { "description": "Testos Total Male ED/LC-MS/MS", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.75, "discounted_cash": 80.0, "minimum": 80.5475, "maximum": 261.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 237.89, "10th_percentile": 237.89, "90th_percentile": 237.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 99.99, "10th_percentile": 99.99, "90th_percentile": 99.99, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 213.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 261.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 208.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.33, "10th_percentile": 96.33, "90th_percentile": 96.33, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 176.93, "10th_percentile": 176.93, "90th_percentile": 176.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.51, "10th_percentile": 218.31, "90th_percentile": 222.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.05, "10th_percentile": 136.22, "90th_percentile": 277.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 277.75, "10th_percentile": 277.75, "90th_percentile": 277.75, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 94.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 102.77, "10th_percentile": 88.88, "90th_percentile": 254.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 102.77, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 94.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.88, "10th_percentile": 88.88, "90th_percentile": 88.88, "count": "1 through 10" } ] } ] }, { "description": "Sensory Integration/15 min OT", "code_information": [ { "code": "97533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.75, "discounted_cash": 24.0, "minimum": 24.2875, "maximum": 83.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.75 } ] } ] }, { "description": "Debridement Nail Any Method 6 or Greater", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.5, "discounted_cash": 75.0, "minimum": 75.545, "maximum": 236.2735, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.48, "10th_percentile": 55.48, "90th_percentile": 88.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 28.24, "10th_percentile": 28.24, "90th_percentile": 28.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.24, "10th_percentile": 28.24, "90th_percentile": 28.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.01, "10th_percentile": 28.24, "90th_percentile": 30.01, "count": "1 through 10" } ] } ] }, { "description": "XR Sternum 2 Views", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.75, "discounted_cash": 142.0, "minimum": 88.66, "maximum": 446.9242, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 88.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 } ] } ] }, { "description": "MRI Cervical Spine w+wo Contrast", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2471.5, "discounted_cash": 716.0, "minimum": 716.735, "maximum": 2471.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2471.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1875.16 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2471.5, "10th_percentile": 2471.5, "90th_percentile": 2471.5, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 21135.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21135.28 } ] } ] }, { "description": "Semen Analysis, Complete", "code_information": [ { "code": "89322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 89.0, "minimum": 89.1025, "maximum": 278.6757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 156.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 125.41 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 143.69 } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7948.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7948.13 } ] } ] }, { "description": "Lidocaine HCl Local Preservative Free (PF) Inj 2%", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "63323049504", "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "XR Forearm Left 2 Views", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 101.0, "minimum": 74.35, "maximum": 318.8105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 269.95, "10th_percentile": 256.91, "90th_percentile": 272.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.54, "10th_percentile": 126.54, "90th_percentile": 126.54, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 281.55, "10th_percentile": 281.55, "90th_percentile": 281.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 351.5, "10th_percentile": 331.5, "90th_percentile": 351.5, "count": "29" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 106.08, "10th_percentile": 106.08, "90th_percentile": 106.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.48, "10th_percentile": 112.48, "90th_percentile": 112.48, "count": "1 through 10" } ] } ] }, { "description": "TX SHLDR DISLOC MANI FAC", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.75, "discounted_cash": 97.0, "minimum": 97.3675, "maximum": 304.5253, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 335.75, "10th_percentile": 335.75, "90th_percentile": 335.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.44, "10th_percentile": 107.44, "90th_percentile": 107.44, "count": "1 through 10" } ] } ] }, { "description": "Monkeypox Virus DNA, QL PCR", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 39.0, "minimum": 39.44, "maximum": 136.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.0 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CCMCC", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 16061.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16061.31 } ] } ] }, { "description": "MRI Thoracic Spine w Contrast", "code_information": [ { "code": "72147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2050.5, "discounted_cash": 594.0, "minimum": 594.645, "maximum": 2050.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2050.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1669.33 } ] } ] }, { "description": "Topiramate Level", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.25, "discounted_cash": 48.0, "minimum": 48.7925, "maximum": 152.6027, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 98.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 96.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 110.5 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 16071.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16071.92 } ] } ] }, { "description": "Legionella pneumophila DFA", "code_information": [ { "code": "87278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 55.0, "minimum": 55.4625, "maximum": 173.4638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.62 } ] } ] }, { "description": "SLP Developmental Testing Units", "code_information": [ { "code": "96110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.25, "discounted_cash": 104.0, "minimum": 95.0, "maximum": 325.8397, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "730", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7922.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7922.19 } ] } ] }, { "description": "JAK2 Exon 12 Mutation Anlysis", "code_information": [ { "code": "81279", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 640.75, "discounted_cash": 185.0, "minimum": 185.8175, "maximum": 640.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 640.75, "10th_percentile": 640.75, "90th_percentile": 640.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 163.04, "10th_percentile": 163.04, "90th_percentile": 163.04, "count": "1 through 10" } ] } ] }, { "description": "Stool, Occult Blood, 3 Screening Samples - 82270 - 3203002", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 17.0, "minimum": 17.545, "maximum": 54.8735, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4.38, "10th_percentile": 4.38, "90th_percentile": 4.38, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 } ] } ] }, { "description": "KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CCMCC", "code_information": [ { "code": "489", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "SLP Assessment of Aphasia Units", "code_information": [ { "code": "96105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 414.0, "discounted_cash": 120.0, "minimum": 95.0, "maximum": 375.498, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Hysterosalpingogram in the OR", "code_information": [ { "code": "74740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 992.25, "discounted_cash": 287.0, "minimum": 228.83, "maximum": 899.9707, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 233.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 228.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.1 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 38810.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38810.5 } ] } ] }, { "description": "INBORN AND OTHER DISORDERS OF METABOLISM", "code_information": [ { "code": "642", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 20805.831, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 11200.0, "10th_percentile": 11200.0, "90th_percentile": 11200.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16765.11 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 3148.0292, "maximum": 19626.29, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10087.83, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4111.74, "10th_percentile": 4111.74, "90th_percentile": 4111.74, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19626.29 } ] } ] }, { "description": "MNT Reassess", "code_information": [ { "code": "97803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "discounted_cash": 17.0, "minimum": 17.545, "maximum": 54.8735, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 77.49, "10th_percentile": 38.74, "90th_percentile": 127.51, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 141.45, "10th_percentile": 141.45, "90th_percentile": 141.45, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.8, "10th_percentile": 36.8, "90th_percentile": 58.65, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 42.76, "10th_percentile": 42.76, "90th_percentile": 64.14, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.2, "10th_percentile": 50.2, "90th_percentile": 50.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 105.34, "10th_percentile": 42.55, "90th_percentile": 164.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.72, "10th_percentile": 38.72, "90th_percentile": 77.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.72, "10th_percentile": 19.55, "90th_percentile": 39.1, "count": "1 through 10" } ] } ] }, { "description": "NM Bone Scan Whole Body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1169.5, "discounted_cash": 339.0, "minimum": 339.155, "maximum": 1169.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 812.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 995.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 796.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1169.5 } ] } ] }, { "description": "IR Spinal Select Each Vessel", "code_information": [ { "code": "75705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3721.0, "discounted_cash": 1079.0, "minimum": 896.63, "maximum": 3374.947, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 914.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1120.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 896.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1147.65 } ] } ] }, { "description": "HIV 1,2 Ab - G0432 - 3358933", "code_information": [ { "code": "G0432", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "minimum": 26.4625, "maximum": 91.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.85, "10th_percentile": 30.96, "90th_percentile": 32.85, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.26, "10th_percentile": 30.26, "90th_percentile": 30.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 27.52, "90th_percentile": 29.2, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 27.52, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.24, "count": "1 through 10" } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "329", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21072.0, "minimum": 21072.36, "maximum": 54188.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54188.05 } ] } ] }, { "description": "Electrical Stimulation Attended/15 min OT", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 26.0, "minimum": 26.3175, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC", "code_information": [ { "code": "815", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 25167.429, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11954.03 } ] } ] }, { "description": "Herpes Simplex Virus (HSV) Culture", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.25, "discounted_cash": 65.0, "minimum": 65.9025, "maximum": 227.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 215.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 227.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.91 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.4, "10th_percentile": 78.4, "90th_percentile": 78.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 227.25, "10th_percentile": 227.25, "90th_percentile": 227.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "1 through 10" } ] } ] }, { "description": "US Scrotum Testes", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 832.0, "discounted_cash": 241.0, "minimum": 241.28, "maximum": 754.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 638.98, "10th_percentile": 638.98, "90th_percentile": 638.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.6, "10th_percentile": 282.6, "90th_percentile": 282.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 427.24 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 341.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 272.24, "10th_percentile": 272.24, "90th_percentile": 272.24, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 529.98, "10th_percentile": 500.05, "90th_percentile": 529.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 628.86, "10th_percentile": 628.86, "90th_percentile": 628.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 594.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 639.68, "10th_percentile": 639.68, "90th_percentile": 639.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 832.0, "10th_percentile": 832.0, "90th_percentile": 832.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 251.2, "10th_percentile": 251.2, "90th_percentile": 266.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 719.06, "10th_percentile": 266.24, "90th_percentile": 754.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 266.24, "10th_percentile": 266.24, "90th_percentile": 266.24, "count": "1 through 10" } ] } ] }, { "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": 8966.0, "minimum": 8966.96, "maximum": 16320.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16320.66 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 10725.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10725.61 } ] } ] }, { "description": "HSV Type 2 Glycoprotein IgG", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.25, "discounted_cash": 72.0, "minimum": 72.8625, "maximum": 227.8837, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.25, "10th_percentile": 251.25, "90th_percentile": 251.25, "count": "1 through 10" } ] } ] }, { "description": "$ Electrolytes 80051", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 27.0, "minimum": 27.405, "maximum": 85.7115, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 70.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 56.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.77, "10th_percentile": 32.77, "90th_percentile": 32.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" } ] } ] }, { "description": "Staphylococcus Latex", "code_information": [ { "code": "87147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 8.0, "minimum": 8.99, "maximum": 31.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 17.54, "10th_percentile": 17.54, "90th_percentile": 17.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.16, "10th_percentile": 11.16, "90th_percentile": 11.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 8.5, "90th_percentile": 21.5, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 20.09, "10th_percentile": 15.61, "90th_percentile": 23.98, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 23.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 7.21, "10th_percentile": 7.21, "90th_percentile": 7.21, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 26.0, "10th_percentile": 24.5, "90th_percentile": 31.0, "count": "93" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 5.18, "90th_percentile": 19.89, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 23.58, "10th_percentile": 20.78, "90th_percentile": 56.23, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.36, "10th_percentile": 7.84, "90th_percentile": 19.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.33, "10th_percentile": 8.32, "90th_percentile": 39.78, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 8.32, "90th_percentile": 9.92, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13898.0, "minimum": 13898.79, "maximum": 70811.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70811.69 } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13450.0, "minimum": 13450.44, "maximum": 33836.73, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33836.73 } ] } ] }, { "description": "Bill IRL Hgb S Ea", "code_information": [ { "code": "85660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 106.0, "minimum": 44.67, "maximum": 333.776, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 44.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.08 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITHOUT CCMCC", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 1673.926, "maximum": 6672.56, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4707.65, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 2143.82, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6672.56 } ] } ] }, { "description": ".Hu Ab, Western Blot,Serum", "code_information": [ { "code": "84181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.25, "discounted_cash": 62.0, "minimum": 62.1325, "maximum": 194.3247, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 140.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 172.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 137.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.88 } ] } ] }, { "description": "NM Thallium 201 MCI", "code_information": [ { "code": "A9505", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.25, "minimum": 85.0425, "maximum": 265.9778, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 122.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.93 } ] } ] }, { "description": "Measles-Mumps-Rubella Virus Vaccines For Inj Soln", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00006468101", "type": "NDC" }, { "code": "90707", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 0.01, "10th_percentile": 0.01, "90th_percentile": 0.01, "count": "1 through 10" } ] } ] }, { "description": "PT Gait Training Units", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 34.0, "minimum": 34.22, "maximum": 107.026, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.96, "10th_percentile": 84.96, "90th_percentile": 84.96, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 24.07, "90th_percentile": 80.32, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.76, "10th_percentile": 37.76, "90th_percentile": 37.76, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 18865.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18865.9 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 1000 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009001820", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 2", "code_information": [ { "code": "99212", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 51.0, "minimum": 51.33, "maximum": 160.539, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 73.82, "10th_percentile": 73.82, "90th_percentile": 73.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.29, "10th_percentile": 34.29, "90th_percentile": 40.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.04, "10th_percentile": 33.04, "90th_percentile": 39.45, "count": "12" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.25, "10th_percentile": 23.88, "90th_percentile": 113.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 37.47, "10th_percentile": 36.86, "90th_percentile": 37.47, "count": "66" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 36.4, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 194.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.8, "10th_percentile": 6.1, "90th_percentile": 145.33, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 36.4, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 38.68, "count": "22" } ] } ] }, { "description": "XR Thoracic SP w Oblique 4 View", "code_information": [ { "code": "72074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 640.75, "discounted_cash": 185.0, "minimum": 132.99, "maximum": 581.1603, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 166.24 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 132.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.18 } ] } ] }, { "description": "Lorazepam Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641604401", "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "NM Bone SPECT CT 78830", "code_information": [ { "code": "78830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6165.25, "discounted_cash": 1787.0, "minimum": 1787.9225, "maximum": 5591.8817, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3121.49 } ] } ] }, { "description": "Sendout BRAF Mutation Detection by Pyrosequencing", "code_information": [ { "code": "81210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1052.0, "discounted_cash": 305.0, "minimum": 305.08, "maximum": 1052.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 451.29 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.98 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 442.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1052.0 } ] } ] }, { "description": "Protein Total - 84155 - 3107017 - 3107017", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.5, "discounted_cash": 21.0, "minimum": 21.895, "maximum": 68.4785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.18, "10th_percentile": 26.18, "90th_percentile": 26.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 75.5, "10th_percentile": 75.5, "90th_percentile": 75.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.04, "10th_percentile": 23.04, "90th_percentile": 23.04, "count": "1 through 10" } ] } ] }, { "description": "NM Thyroid Uptake Only", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 144.0, "minimum": 144.275, "maximum": 497.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 310.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.5 } ] } ] }, { "description": "MRI Unlisted Procedure", "code_information": [ { "code": "76498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1779.0, "discounted_cash": 515.0, "minimum": 515.91, "maximum": 1613.553, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "Amikacin Level", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.25, "discounted_cash": 34.0, "minimum": 34.5825, "maximum": 119.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 119.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.25 } ] } ] }, { "description": "Mercury Level, Blood", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.25, "discounted_cash": 67.0, "minimum": 67.9325, "maximum": 212.4648, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 134.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 164.45 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 131.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 234.25, "10th_percentile": 234.25, "90th_percentile": 234.25, "count": "1 through 10" } ] } ] }, { "description": "Mycoplasma pneumoniae", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.0, "discounted_cash": 17.0, "minimum": 17.69, "maximum": 61.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 47.15, "10th_percentile": 47.15, "90th_percentile": 47.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 46.06, "10th_percentile": 46.06, "90th_percentile": 46.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 57.5, "10th_percentile": 57.5, "90th_percentile": 61.0, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 18.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 55.33, "10th_percentile": 19.52, "90th_percentile": 110.66, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.4, "10th_percentile": 18.4, "90th_percentile": 21.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.55, "10th_percentile": 19.55, "90th_percentile": 19.55, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.55, "10th_percentile": 19.55, "90th_percentile": 19.55, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 25839.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25839.09 } ] } ] }, { "description": "PCB Panel, Congers, Serum/Plasma", "code_information": [ { "code": "82441", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 61.0, "minimum": 48.54, "maximum": 191.6037, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.72 } ] } ] }, { "description": "von Willebrand Factor Antigen", "code_information": [ { "code": "85244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.0, "discounted_cash": 82.0, "minimum": 82.36, "maximum": 257.588, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 168.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 206.49 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 165.2 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.3 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 284.0, "10th_percentile": 284.0, "90th_percentile": 284.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.88, "10th_percentile": 90.88, "90th_percentile": 90.88, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC", "code_information": [ { "code": "940", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 27549.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27549.67 } ] } ] }, { "description": "Clonazepam (Klonopin) Level - 80346 - 3358706", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282.25, "discounted_cash": 81.0, "minimum": 81.8525, "maximum": 256.0007, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.35 } ] } ] }, { "description": "XR Esophagram Single 74220", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 273.0, "minimum": 247.38, "maximum": 855.9813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 252.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.38 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 586.49 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "502", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 15866.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15866.79 } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC", "code_information": [ { "code": "605", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 11684.898, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10798.71 } ] } ] }, { "description": "HIV Phenosense Entry", "code_information": [ { "code": "87903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2476.0, "discounted_cash": 718.0, "minimum": 718.04, "maximum": 2476.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2476.0 } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9503.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9503.1 } ] } ] }, { "description": "NM Testicular Scan w Flow", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.0, "discounted_cash": 173.0, "minimum": 173.13, "maximum": 597.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 597.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.0 } ] } ] }, { "description": "IMMUNO EHEC test", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 8.0, "minimum": 8.99, "maximum": 31.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 10.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 23.43, "10th_percentile": 23.43, "90th_percentile": 23.43, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 29.25, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 22.67, "10th_percentile": 22.67, "90th_percentile": 22.67, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 31.0, "10th_percentile": 29.25, "90th_percentile": 31.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 9.36, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.36, "10th_percentile": 9.36, "90th_percentile": 9.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.95, "10th_percentile": 9.92, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.92, "10th_percentile": 9.92, "90th_percentile": 9.92, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 8524.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8524.61 } ] } ] }, { "description": "Phenytoin Level", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.75, "discounted_cash": 46.0, "minimum": 46.3275, "maximum": 144.8932, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.29, "10th_percentile": 52.29, "90th_percentile": 52.29, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.31, "10th_percentile": 98.31, "90th_percentile": 98.31, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.24, "10th_percentile": 48.24, "90th_percentile": 48.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.12, "10th_percentile": 51.12, "90th_percentile": 51.12, "count": "1 through 10" } ] } ] }, { "description": "Protein C, Functional", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.0, "discounted_cash": 78.0, "minimum": 78.01, "maximum": 243.983, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 103.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.3 } ] } ] }, { "description": "Vasopneumatic Devices OT", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.25, "discounted_cash": 32.0, "minimum": 32.2625, "maximum": 100.9038, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Corticosteriod Binding Globulin", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 61.0, "minimum": 61.335, "maximum": 191.8305, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 142.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.87 } ] } ] }, { "description": "NM Urinary Bladder Residual Study", "code_information": [ { "code": "78730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.25, "discounted_cash": 49.0, "minimum": 49.3725, "maximum": 170.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 170.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.25 } ] } ] }, { "description": "MPL Mutation Analysis", "code_information": [ { "code": "81339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 915.25, "discounted_cash": 265.0, "minimum": 265.4225, "maximum": 915.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 915.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.88, "10th_percentile": 232.88, "90th_percentile": 232.88, "count": "1 through 10" } ] } ] }, { "description": "Potassium Chloride Inj 2 mEq/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "63323096503", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "zz.U Microalb - 82043 - 3350129 - 3350129", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.0, "discounted_cash": 36.0, "minimum": 36.83, "maximum": 115.189, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 86.82, "10th_percentile": 86.82, "90th_percentile": 86.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.65, "10th_percentile": 43.65, "90th_percentile": 43.65, "count": "43" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 43.28 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.05, "10th_percentile": 42.05, "90th_percentile": 42.05, "count": "40" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 77.24, "10th_percentile": 77.24, "90th_percentile": 77.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 95.3, "10th_percentile": 95.3, "90th_percentile": 97.13, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.88, "10th_percentile": 15.68, "90th_percentile": 116.93, "count": "36" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 28.18, "10th_percentile": 28.18, "90th_percentile": 28.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.25, "10th_percentile": 121.25, "90th_percentile": 121.25, "count": "53" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "104" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 111.07, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 44.86, "count": "76" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 38.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.8, "10th_percentile": 38.8, "90th_percentile": 41.23, "count": "58" } ] } ] }, { "description": "T3 Resin Uptake", "code_information": [ { "code": "84479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.75, "discounted_cash": 33.0, "minimum": 33.8575, "maximum": 105.8923, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 16866.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16688.48 } ] } ] }, { "description": "Immunofixation Electrophoresis, Serum", "code_information": [ { "code": "86334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.25, "discounted_cash": 81.0, "minimum": 81.2725, "maximum": 254.1867, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.98, "10th_percentile": 60.03, "90th_percentile": 78.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 184.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 225.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 180.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.52, "10th_percentile": 75.52, "90th_percentile": 75.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 205.5, "10th_percentile": 205.5, "90th_percentile": 217.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.76, "10th_percentile": 22.34, "90th_percentile": 69.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 65.76, "10th_percentile": 65.76, "90th_percentile": 76.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.76, "10th_percentile": 53.36, "90th_percentile": 76.04, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.68, "10th_percentile": 53.36, "90th_percentile": 69.87, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.36, "10th_percentile": 53.36, "90th_percentile": 53.36, "count": "1 through 10" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 36091.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36091.96 } ] } ] }, { "description": "CT Simulation Intermediate", "code_information": [ { "code": "77285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1353.25, "discounted_cash": 392.0, "minimum": 392.4425, "maximum": 1312.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1070.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1049.64 } ] } ] }, { "description": "MRI Forearm Left w Contrast", "code_information": [ { "code": "73219", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 626.0, "minimum": 626.11, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2120.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1696.07 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 } ] } ] }, { "description": "Bilirubin, Conjugated", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 10.0, "minimum": 10.9475, "maximum": 37.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 27.03, "10th_percentile": 27.03, "90th_percentile": 27.03, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.59, "10th_percentile": 13.59, "90th_percentile": 13.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.1, "10th_percentile": 13.1, "90th_percentile": 13.1, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 30.24, "10th_percentile": 29.67, "90th_percentile": 30.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 37.75, "10th_percentile": 37.75, "90th_percentile": 37.75, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 30.17, "10th_percentile": 12.08, "90th_percentile": 34.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 12.08, "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": 22641.0, "minimum": 22641.57, "maximum": 84109.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84109.66 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 30676.9725, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8901.96, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6467.57, "10th_percentile": 6467.57, "90th_percentile": 10979.72, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 17549.28, "10th_percentile": 5849.76, "90th_percentile": 40948.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 54285.76, "10th_percentile": 41344.96, "90th_percentile": 70615.1, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13275.57 } ] } ] }, { "description": "Albumin, CSF", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.5, "discounted_cash": 10.0, "minimum": 10.005, "maximum": 34.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.5 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 17618.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17618.63 } ] } ] }, { "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": 532.0, "minimum": 532.2225, "maximum": 1664.5718, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 534.56, "10th_percentile": 534.56, "90th_percentile": 534.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 535.84, "10th_percentile": 535.84, "90th_percentile": 535.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1670.5, "10th_percentile": 1670.5, "90th_percentile": 1670.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 504.32, "10th_percentile": 504.32, "90th_percentile": 504.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 534.56, "10th_percentile": 504.32, "90th_percentile": 583.12, "count": "1 through 10" } ] } ] }, { "description": "Prolactin Level", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.25, "discounted_cash": 56.0, "minimum": 56.3325, "maximum": 194.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.83 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 123.74, "10th_percentile": 123.74, "90th_percentile": 123.74, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.4, "10th_percentile": 40.4, "90th_percentile": 40.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 194.25, "10th_percentile": 194.25, "90th_percentile": 194.25, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 66.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 176.18, "10th_percentile": 176.18, "90th_percentile": 176.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.16, "10th_percentile": 62.16, "90th_percentile": 71.87, "count": "1 through 10" } ] } ] }, { "description": "88302 AP Bill Surgical Pathology Level II Complexity", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.0, "discounted_cash": 119.0, "minimum": 119.48, "maximum": 373.684, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 268.91, "10th_percentile": 268.91, "90th_percentile": 268.91, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 306.2 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 412.0, "10th_percentile": 412.0, "90th_percentile": 412.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.84, "10th_percentile": 131.84, "90th_percentile": 140.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 377.39, "10th_percentile": 377.39, "90th_percentile": 377.39, "count": "1 through 10" } ] } ] }, { "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": 107.0, "minimum": 107.2275, "maximum": 369.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 264.74, "10th_percentile": 264.74, "90th_percentile": 1058.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.11, "10th_percentile": 133.11, "90th_percentile": 532.44, "count": "47" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 241.34, "10th_percentile": 236.79, "90th_percentile": 482.68, "count": "83" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.23, "10th_percentile": 128.23, "90th_percentile": 512.92, "count": "16" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 303.19, "10th_percentile": 296.17, "90th_percentile": 909.58, "count": "16" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 290.62, "10th_percentile": 290.62, "90th_percentile": 296.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 369.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.72, "10th_percentile": 65.44, "90th_percentile": 130.88, "count": "11" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 85.95, "10th_percentile": 85.95, "90th_percentile": 264.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 369.75, "10th_percentile": 369.75, "90th_percentile": 1109.25, "count": "74" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.32, "10th_percentile": 118.32, "90th_percentile": 354.96, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 338.69, "10th_percentile": 136.81, "90th_percentile": 3219.56, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2386.32, "10th_percentile": 118.32, "90th_percentile": 3305.72, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.72, "10th_percentile": 118.32, "90th_percentile": 377.15, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.72, "10th_percentile": 118.32, "90th_percentile": 377.15, "count": "25" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 16720.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16720.31 } ] } ] }, { "description": "US Amniocentesis", "code_information": [ { "code": "76946", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 857.25, "discounted_cash": 248.0, "minimum": 104.4, "maximum": 777.5258, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 129.69 } ] } ] }, { "description": "XR Perc Tube-Catheter Change", "code_information": [ { "code": "75984", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1146.75, "discounted_cash": 332.0, "minimum": 304.6, "maximum": 1040.1022, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 310.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 304.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 490.61 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 6067.5631, "maximum": 10407.31, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7756.07, "10th_percentile": 4282.63, "90th_percentile": 14860.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7397.74, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12300.0, "10th_percentile": 12300.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10407.31 } ] } ] }, { "description": "XR UGI Double Contrast 74246", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 273.0, "minimum": 273.6875, "maximum": 855.9813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 350.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 343.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 820.53 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18577.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18577.07 } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITH CC", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 13194.1476, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7262.12, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10185.96, "10th_percentile": 10185.96, "90th_percentile": 10185.96, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12584.74 } ] } ] }, { "description": "88333 AP Bill Non-Gyn Cytology Intraoperative consult", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.5, "discounted_cash": 51.0, "minimum": 51.765, "maximum": 178.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.5 } ] } ] }, { "description": "Continuous Nebulizer Treatment Initial", "code_information": [ { "code": "94644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.25, "discounted_cash": 121.0, "minimum": 121.8725, "maximum": 381.1667, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 310.19, "10th_percentile": 310.19, "90th_percentile": 322.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.29, "10th_percentile": 144.09, "90th_percentile": 151.29, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.75, "10th_percentile": 145.75, "90th_percentile": 145.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 420.25, "10th_percentile": 400.25, "90th_percentile": 420.25, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 134.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 366.63, "10th_percentile": 366.63, "90th_percentile": 366.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 148.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.08, "10th_percentile": 128.08, "90th_percentile": 134.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.09, "10th_percentile": 136.09, "90th_percentile": 136.09, "count": "1 through 10" } ] } ] }, { "description": "US Doppler Veloc Fetal Umbilical Art", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 119.0, "minimum": 118.68, "maximum": 374.8177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 148.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 118.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 } ] } ] }, { "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": 13226.0, "minimum": 13226.27, "maximum": 37253.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37253.18 } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "724", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7730.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7730.03 } ] } ] }, { "description": "OT Group Train WO Patient Unit", "code_information": [ { "code": "G0543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.5, "minimum": 25.955, "maximum": 89.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.5 } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC", "code_information": [ { "code": "964", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 18067.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18067.79 } ] } ] }, { "description": "Metoclopramide HCl Inj 5 MG/ML (Base Equivalent)", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "00409341421", "type": "NDC" }, { "code": "J2765", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 19.35, "10th_percentile": 12.77, "90th_percentile": 19.35, "count": "1 through 10" } ] } ] }, { "description": "Adenovirus", "code_information": [ { "code": "87633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 396.5, "discounted_cash": 114.0, "minimum": 114.985, "maximum": 396.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 396.5 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 299.61, "10th_percentile": 299.61, "90th_percentile": 299.61, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.24, "10th_percentile": 36.24, "90th_percentile": 36.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 374.0, "10th_percentile": 374.0, "90th_percentile": 396.5, "count": "52" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 119.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 359.63, "10th_percentile": 126.88, "90th_percentile": 719.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 138.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.16, "10th_percentile": 127.16, "90th_percentile": 127.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.16, "10th_percentile": 127.16, "90th_percentile": 127.16, "count": "1 through 10" } ] } ] }, { "description": "Hydromorphone HCl Inj 2 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641615101", "type": "NDC" }, { "code": "J1171", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 25.55, "count": "34" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 6.25, "count": "1 through 10" } ] } ] }, { "description": "ORBITAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 27717.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27717.07 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC", "code_information": [ { "code": "698", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 19503.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19503.69 } ] } ] }, { "description": "IGVH Status", "code_information": [ { "code": "81263", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1025.0, "discounted_cash": 297.0, "minimum": 297.25, "maximum": 1025.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1025.0 } ] } ] }, { "description": "XR Cervical Spine Portable Lateral", "code_information": [ { "code": "72020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.25, "discounted_cash": 98.0, "minimum": 61.5, "maximum": 309.5138, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 62.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 61.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.02 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "903", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 13788.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13788.39 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 21260.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21260.25 } ] } ] }, { "description": "URETHRAL STRICTURE", "code_information": [ { "code": "697", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 12706.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12706.16 } ] } ] }, { "description": "CT Pudendal Nerve Injection 64430", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2938.25, "discounted_cash": 852.0, "minimum": 650.0, "maximum": 2664.9927, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "Giardia Antigen, Stool", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.75, "discounted_cash": 38.0, "minimum": 38.4975, "maximum": 120.4043, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.44, "10th_percentile": 43.44, "90th_percentile": 43.44, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 100.34, "10th_percentile": 100.34, "90th_percentile": 100.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 132.75, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.98, "10th_percentile": 11.98, "90th_percentile": 11.98, "count": "1 through 10" } ] } ] }, { "description": "NM Lung Quant Perf Only", "code_information": [ { "code": "78597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 713.25, "discounted_cash": 206.0, "minimum": 206.8425, "maximum": 713.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.73 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 713.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 643.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 713.25 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 31358.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31358.69 } ] } ] }, { "description": "MRI Angio Head w+wo Contrast", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2948.5, "discounted_cash": 855.0, "minimum": 855.065, "maximum": 2674.2895, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "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": 2286.83 } ] } ] }, { "description": "XR Cholangiogram Intraoperative Addition", "code_information": [ { "code": "74301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1225.75, "discounted_cash": 355.0, "minimum": 80.1, "maximum": 1111.7552, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.29 } ] } ] }, { "description": "Lyme DNA, PCR", "code_information": [ { "code": "87801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.5, "discounted_cash": 82.0, "minimum": 82.215, "maximum": 283.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 191.53, "10th_percentile": 191.53, "90th_percentile": 217.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.77, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 170.4, "10th_percentile": 170.4, "90th_percentile": 170.4, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 222.83, "10th_percentile": 222.83, "90th_percentile": 222.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 283.5, "10th_percentile": 267.5, "90th_percentile": 283.5, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 85.6, "90th_percentile": 90.72, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 257.13, "10th_percentile": 257.13, "90th_percentile": 257.13, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.72, "10th_percentile": 90.72, "90th_percentile": 90.72, "count": "1 through 10" } ] } ] }, { "description": "NM Bone Scan 3 Phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1415.25, "discounted_cash": 410.0, "minimum": 410.4225, "maximum": 1415.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 994.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1219.13 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 975.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1415.25 } ] } ] }, { "description": "US Obstetrical Transvaginal", "code_information": [ { "code": "76817", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.25, "discounted_cash": 162.0, "minimum": 162.1825, "maximum": 507.2398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 377.69, "10th_percentile": 377.69, "90th_percentile": 377.69, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 356.24, "10th_percentile": 356.24, "90th_percentile": 356.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 485.01 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 429.5, "10th_percentile": 429.5, "90th_percentile": 429.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 559.25, "10th_percentile": 527.5, "90th_percentile": 559.25, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 483.19, "10th_percentile": 483.19, "90th_percentile": 483.19, "count": "1 through 10" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC", "code_information": [ { "code": "351", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 17972.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17972.3 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH CC", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 67148.928, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 9136.22, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 33807.6, "10th_percentile": 33807.6, "90th_percentile": 33807.6, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14231.66 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7099.7798, "maximum": 12119.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12119.07 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 36654.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36654.3 } ] } ] }, { "description": ".JAK2 Exons 12, 13 Mutations, Qual", "code_information": [ { "code": "81403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1863.75, "discounted_cash": 540.0, "minimum": 540.4875, "maximum": 1863.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1556.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1863.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1526.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1716.9 } ] } ] }, { "description": "MA NP OP Consult New L2", "code_information": [ { "code": "99202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.5, "discounted_cash": 40.0, "minimum": 40.745, "maximum": 127.4335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.36, "10th_percentile": 104.36, "90th_percentile": 104.36, "count": "1 through 10" } ] } ] }, { "description": "IGF-1 (Insulin-Like Growth Factor 1)", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 59.0, "minimum": 59.16, "maximum": 197.0908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 204.0, "10th_percentile": 204.0, "90th_percentile": 204.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.28, "10th_percentile": 65.28, "90th_percentile": 65.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.48, "10th_percentile": 75.48, "90th_percentile": 75.48, "count": "1 through 10" } ] } ] }, { "description": "Folate, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 60.0, "minimum": 60.03, "maximum": 187.749, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 129.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.63 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 126.9 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.62 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 25106.0549, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20903.04 } ] } ] }, { "description": "Alpha-1 Globulins", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.5, "discounted_cash": 66.0, "minimum": 66.555, "maximum": 208.1565, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 164.32, "10th_percentile": 164.32, "90th_percentile": 164.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.62, "10th_percentile": 78.66, "90th_percentile": 82.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 86.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.59, "10th_percentile": 79.59, "90th_percentile": 104.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.5, "10th_percentile": 229.5, "90th_percentile": 229.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 10.74, "90th_percentile": 73.44, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 208.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 69.92, "90th_percentile": 84.92, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.44, "10th_percentile": 73.44, "90th_percentile": 73.44, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.92, "10th_percentile": 69.92, "90th_percentile": 73.44, "count": "1 through 10" } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "314", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 8280.175, "maximum": 24582.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24582.38 } ] } ] }, { "description": "CT Urogram 74178", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3122.5, "discounted_cash": 905.0, "minimum": 650.0, "maximum": 2832.1075, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2282.96, "10th_percentile": 2282.96, "90th_percentile": 2282.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1060.47, "10th_percentile": 1060.47, "90th_percentile": 1124.1, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1748.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1398.61 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1021.59, "10th_percentile": 1021.59, "90th_percentile": 1082.88, "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": 78.6, "median_amount": 2359.84, "10th_percentile": 2359.84, "90th_percentile": 2359.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2162.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 914.2, "10th_percentile": 914.2, "90th_percentile": 914.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2945.75, "10th_percentile": 2945.75, "90th_percentile": 3122.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 999.2, "10th_percentile": 942.64, "90th_percentile": 1001.56, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 999.2, "10th_percentile": 999.2, "90th_percentile": 999.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 999.2, "10th_percentile": 999.2, "90th_percentile": 999.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 999.2, "10th_percentile": 942.64, "90th_percentile": 1001.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 942.64, "10th_percentile": 942.64, "90th_percentile": 999.2, "count": "1 through 10" } ] } ] }, { "description": "URETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "672", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 12726.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12726.2 } ] } ] }, { "description": "CT Heart wo Dye Qual Calc", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.0, "discounted_cash": 73.0, "minimum": 73.37, "maximum": 253.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 223.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 178.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.0 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC", "code_information": [ { "code": "674", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 27569.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27569.71 } ] } ] }, { "description": "AUARC - 86927 - 3001021", "code_information": [ { "code": "86927", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 829.5, "discounted_cash": 240.0, "minimum": 218.2276, "maximum": 752.3565, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 218.23 } ] } ] }, { "description": "$ Platelets, pheresis, irr, ea unit", "code_information": [ { "code": "P9036", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3071.75, "minimum": 890.8075, "maximum": 2786.0772, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1967.15, "10th_percentile": 1967.15, "90th_percentile": 1967.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 982.96, "10th_percentile": 982.96, "90th_percentile": 982.96, "count": "1 through 10" } ] } ] }, { "description": "CT Entire Lower Extrem RT WO Contrast", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 503.0, "minimum": 503.15, "maximum": 1573.645, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 547.92, "10th_percentile": 545.58, "90th_percentile": 547.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.13, "10th_percentile": 527.83, "90th_percentile": 601.7, "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": 78.6, "median_amount": 1150.18, "10th_percentile": 1150.18, "90th_percentile": 2033.86, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 727.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 487.04, "10th_percentile": 210.27, "90th_percentile": 1456.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1522.0, "10th_percentile": 1435.75, "90th_percentile": 1522.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 487.04, "10th_percentile": 459.44, "90th_percentile": 974.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 919.04, "10th_percentile": 919.04, "90th_percentile": 919.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 531.23, "10th_percentile": 514.08, "90th_percentile": 974.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 523.76, "10th_percentile": 487.04, "90th_percentile": 556.5, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.96, "10th_percentile": 484.96, "90th_percentile": 555.2, "count": "1 through 10" } ] } ] }, { "description": ".HPV Genotypes 16 & 18/45", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.25, "discounted_cash": 88.0, "minimum": 88.5225, "maximum": 305.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 206.21, "10th_percentile": 206.21, "90th_percentile": 206.21, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 200.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.56 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 196.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 288.0, "10th_percentile": 288.0, "90th_percentile": 305.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.68, "10th_percentile": 97.68, "90th_percentile": 97.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 92.16, "count": "1 through 10" } ] } ] }, { "description": "Helicobacterpylori Antigen, Stool", "code_information": [ { "code": "87338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.0, "discounted_cash": 117.0, "minimum": 92.88, "maximum": 367.335, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.8, "10th_percentile": 145.8, "90th_percentile": 145.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.88 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 306.02, "10th_percentile": 306.02, "90th_percentile": 306.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 382.0, "10th_percentile": 382.0, "90th_percentile": 405.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.38, "10th_percentile": 14.38, "90th_percentile": 14.38, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 305.33, "10th_percentile": 305.33, "90th_percentile": 305.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.62, "10th_percentile": 84.62, "90th_percentile": 129.6, "count": "1 through 10" } ] } ] }, { "description": "Influenza A NAT", "code_information": [ { "code": "87502", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.25, "discounted_cash": 111.0, "minimum": 111.1425, "maximum": 383.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 383.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 383.25, "10th_percentile": 383.25, "90th_percentile": 383.25, "count": "1 through 10" } ] } ] }, { "description": "Vasoactive Intestinal Peptide (VIP)", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539.5, "discounted_cash": 156.0, "minimum": 154.5, "maximum": 489.3265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 157.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 193.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 154.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.53 } ] } ] }, { "description": "Des-gamma-carboxy Prothrombin", "code_information": [ { "code": "83951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.5, "discounted_cash": 69.0, "minimum": 69.165, "maximum": 238.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 238.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.5 } ] } ] }, { "description": "FINGER SPLINT FAC", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.0, "discounted_cash": 134.0, "minimum": 134.56, "maximum": 420.848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 159.12, "10th_percentile": 159.12, "90th_percentile": 159.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 442.0, "10th_percentile": 442.0, "90th_percentile": 464.0, "count": "1 through 10" } ] } ] }, { "description": "XR Ankle Left AP+Lateral", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.75, "discounted_cash": 90.0, "minimum": 72.92, "maximum": 282.7572, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 72.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 294.0, "10th_percentile": 294.0, "90th_percentile": 294.0, "count": "1 through 10" } ] } ] }, { "description": "96416 CHMO ADMIN IV INFUS 1-8HR - G0498 - 7336416", "code_information": [ { "code": "G0498", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1267.0, "minimum": 367.43, "maximum": 1149.169, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 386.16, "10th_percentile": 386.16, "90th_percentile": 386.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 405.44, "10th_percentile": 405.44, "90th_percentile": 405.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.3, "10th_percentile": 410.3, "90th_percentile": 410.3, "count": "1 through 10" } ] } ] }, { "description": "Sodium Level", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.75, "discounted_cash": 10.0, "minimum": 10.9475, "maximum": 37.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.6, "10th_percentile": 35.6, "90th_percentile": 35.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.08, "10th_percentile": 12.08, "90th_percentile": 13.97, "count": "1 through 10" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITHOUT CCMCC", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 14211.765, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 4931.83, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15006.74, "10th_percentile": 15006.74, "90th_percentile": 15599.36, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7409.37 } ] } ] }, { "description": "99285 - Level 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2545.75, "discounted_cash": 738.0, "minimum": 738.2675, "maximum": 2545.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1585.05, "10th_percentile": 674.92, "90th_percentile": 1585.05, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 916.47, "10th_percentile": 796.95, "90th_percentile": 916.47, "count": "35" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 2545.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 2545.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2545.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 882.87, "10th_percentile": 767.73, "90th_percentile": 882.87, "count": "48" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1815.28, "10th_percentile": 1815.28, "90th_percentile": 1815.28, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 2000.96, "10th_percentile": 1773.44, "90th_percentile": 2000.96, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1769.45, "10th_percentile": 1769.45, "90th_percentile": 2698.64, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1426.99, "10th_percentile": 548.79, "90th_percentile": 2545.75, "count": "112" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1031.26, "10th_percentile": 1031.26, "90th_percentile": 1585.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2545.75, "10th_percentile": 2213.75, "90th_percentile": 2545.75, "count": "374" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "120" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2027.8, "10th_percentile": 814.64, "90th_percentile": 2331.91, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 110.0, "90th_percentile": 814.64, "count": "116" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "96" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 814.64, "10th_percentile": 708.4, "90th_percentile": 814.64, "count": "47" } ] } ] }, { "description": "Bill Chr Anal Per Bld Interpret", "code_information": [ { "code": "88291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.5, "discounted_cash": 88.0, "minimum": 88.305, "maximum": 304.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 304.5 } ] } ] }, { "description": "Hemosiderin, Urine", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 23.0, "minimum": 23.49, "maximum": 73.467, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.03 } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITHOUT MCC", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 19165.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11332.75 } ] } ] }, { "description": "HPV High Risk Screen by TMA", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 51.0, "minimum": 51.1125, "maximum": 176.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.04, "10th_percentile": 119.04, "90th_percentile": 119.04, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 63.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.13, "10th_percentile": 61.13, "90th_percentile": 61.13, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 112.27, "10th_percentile": 105.9, "90th_percentile": 112.27, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 138.53, "10th_percentile": 133.18, "90th_percentile": 138.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.35, "10th_percentile": 55.35, "90th_percentile": 103.04, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 38.64, "10th_percentile": 38.08, "90th_percentile": 42.11, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.25, "10th_percentile": 166.25, "90th_percentile": 176.25, "count": "104" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.2, "10th_percentile": 35.09, "90th_percentile": 56.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.28, "10th_percentile": 56.4, "90th_percentile": 159.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.4, "10th_percentile": 53.2, "90th_percentile": 56.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.2, "10th_percentile": 53.2, "90th_percentile": 56.4, "count": "1 through 10" } ] } ] }, { "description": "MRI Angio Neck wo Contrast", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1524.25, "discounted_cash": 442.0, "minimum": 442.0325, "maximum": 1524.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1524.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.22 } ] } ] }, { "description": "INS TEMP BLADDER CATHETER FAC", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 391.5, "discounted_cash": 113.0, "minimum": 113.535, "maximum": 355.0905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.94, "10th_percentile": 140.94, "90th_percentile": 140.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 135.77, "10th_percentile": 135.77, "90th_percentile": 135.77, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 372.75, "10th_percentile": 372.75, "90th_percentile": 372.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.28, "10th_percentile": 125.28, "90th_percentile": 125.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 137.92, "10th_percentile": 125.28, "90th_percentile": 137.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.28, "10th_percentile": 125.28, "90th_percentile": 125.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 119.28, "count": "1 through 10" } ] } ] }, { "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": 8966.0, "minimum": 8966.96, "maximum": 24498.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24498.68 } ] } ] }, { "description": "Hepatitis D Virus Antibody", "code_information": [ { "code": "86692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.5, "discounted_cash": 74.0, "minimum": 74.095, "maximum": 231.7385, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.08 } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITH CCMCC", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 21353.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21353.38 } ] } ] }, { "description": "XR Pyelogram Retrograde", "code_information": [ { "code": "74420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1540.0, "discounted_cash": 446.0, "minimum": 421.89, "maximum": 1396.78, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 430.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 527.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 456.81 } ] } ] }, { "description": "88172 AP Bill FNA Immediate read", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 37.0, "minimum": 37.12, "maximum": 128.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.0 } ] } ] }, { "description": "ALT (Alanine Aminotransferase)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 20.0, "minimum": 20.88, "maximum": 65.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.76, "10th_percentile": 61.76, "90th_percentile": 61.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.05, "10th_percentile": 31.05, "90th_percentile": 31.05, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 42.84 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.92, "10th_percentile": 29.92, "90th_percentile": 29.92, "count": "13" }, { "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": 78.6, "median_amount": 67.79, "10th_percentile": 67.79, "90th_percentile": 128.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.25, "10th_percentile": 16.26, "90th_percentile": 86.25, "count": "12" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 66.84, "10th_percentile": 66.84, "90th_percentile": 66.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.25, "10th_percentile": 60.0, "90th_percentile": 160.0, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 29.33, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 31.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 31.91, "count": "20" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.6, "10th_percentile": 27.6, "90th_percentile": 29.33, "count": "1 through 10" } ] } ] }, { "description": "75833 FAC VENOGRAM RENAL BILATERAL", "code_information": [ { "code": "75833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7562.25, "discounted_cash": 2193.0, "minimum": 671.1055, "maximum": 6858.9608, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 895.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1097.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 878.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 671.11 } ] } ] }, { "description": "Cholinesterase, Serum", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.75, "discounted_cash": 56.0, "minimum": 56.4775, "maximum": 176.6382, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.73 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 63.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.96 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14347.0, "minimum": 14347.14, "maximum": 53600.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53600.96 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CCMCC", "code_information": [ { "code": "742", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 21630.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21630.42 } ] } ] }, { "description": "Occult Blood FIT, Stool", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 26.0, "minimum": 26.97, "maximum": 93.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.48, "10th_percentile": 33.48, "90th_percentile": 33.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.25, "10th_percentile": 32.25, "90th_percentile": 32.25, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 73.1, "10th_percentile": 73.1, "90th_percentile": 73.1, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 15.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 93.0, "10th_percentile": 93.0, "90th_percentile": 93.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.92, "10th_percentile": 15.92, "90th_percentile": 29.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 29.76, "10th_percentile": 29.76, "90th_percentile": 29.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.76, "10th_percentile": 29.76, "90th_percentile": 29.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.62, "10th_percentile": 31.62, "90th_percentile": 31.62, "count": "1 through 10" } ] } ] }, { "description": "75893 FAC VEN SAMPLE SELECT RENIN", "code_information": [ { "code": "75893", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1478.75, "discounted_cash": 428.0, "minimum": 428.8375, "maximum": 1341.2262, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 843.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1033.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 826.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.77 } ] } ] }, { "description": "Estrone, Serum", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.0, "discounted_cash": 33.0, "minimum": 33.64, "maximum": 116.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 } ] } ] }, { "description": "BD DXA Bone Density Appendclr", "code_information": [ { "code": "77081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 307.25, "discounted_cash": 89.0, "minimum": 77.24, "maximum": 278.6757, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.31, "10th_percentile": 104.31, "90th_percentile": 110.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.25, "10th_percentile": 289.75, "90th_percentile": 307.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 92.72, "90th_percentile": 98.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 98.32, "10th_percentile": 98.32, "90th_percentile": 98.52, "count": "1 through 10" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 34333.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34333.05 } ] } ] }, { "description": "Triiodothyronine, Free (T3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.5, "discounted_cash": 51.0, "minimum": 51.185, "maximum": 171.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 126.37, "10th_percentile": 126.37, "90th_percentile": 126.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.54, "10th_percentile": 63.54, "90th_percentile": 63.54, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 137.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.21, "10th_percentile": 61.21, "90th_percentile": 61.21, "count": "11" }, { "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": 112.43, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 138.73, "10th_percentile": 138.73, "90th_percentile": 141.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 167.04, "10th_percentile": 122.87, "90th_percentile": 176.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 176.5, "10th_percentile": 176.5, "90th_percentile": 176.5, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 60.01, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 160.09, "10th_percentile": 56.48, "90th_percentile": 160.09, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 56.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.48, "10th_percentile": 56.48, "90th_percentile": 60.01, "count": "13" } ] } ] }, { "description": "Procalcitonin", "code_information": [ { "code": "86352", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 343.75, "discounted_cash": 99.0, "minimum": 99.6875, "maximum": 343.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 232.16, "10th_percentile": 232.16, "90th_percentile": 232.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.22, "10th_percentile": 119.22, "90th_percentile": 119.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 343.75, "10th_percentile": 324.25, "90th_percentile": 343.75, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 297.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.76, "10th_percentile": 103.76, "90th_percentile": 110.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 110.25, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.0, "10th_percentile": 110.0, "90th_percentile": 110.25, "count": "1 through 10" } ] } ] }, { "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": 8294.0, "minimum": 8294.44, "maximum": 32075.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32075.46 } ] } ] }, { "description": "CT Neck w+wo Contrast", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2882.5, "discounted_cash": 835.0, "minimum": 650.0, "maximum": 2614.4275, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1642.8 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1314.23 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1280.2 } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "627", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 15659.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15659.3 } ] } ] }, { "description": "NM Myoview", "code_information": [ { "code": "A9502", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 367.5, "minimum": 106.575, "maximum": 367.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 320.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.99 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC", "code_information": [ { "code": "319", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16588.0, "minimum": 16588.88, "maximum": 52613.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52613.04 } ] } ] }, { "description": "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "956", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 44361.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44361.93 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 21004.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21004.43 } ] } ] }, { "description": "XR Acute Abdomen w PA Chest", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 771.0, "discounted_cash": 223.0, "minimum": 125.85, "maximum": 699.297, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 261.81, "10th_percentile": 261.81, "90th_percentile": 261.81, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 128.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 125.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 252.22, "10th_percentile": 252.22, "90th_percentile": 252.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 727.25, "10th_percentile": 727.25, "90th_percentile": 771.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 232.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.72, "10th_percentile": 232.72, "90th_percentile": 232.72, "count": "1 through 10" } ] } ] }, { "description": "NM Lung Perfusion Scan", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 978.5, "discounted_cash": 283.0, "minimum": 283.765, "maximum": 978.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 676.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 829.45 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 663.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 978.5 } ] } ] }, { "description": "CT Temp Bones w Contrast", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1804.5, "discounted_cash": 523.0, "minimum": 523.305, "maximum": 1636.6815, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1524.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1219.86 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1804.5, "10th_percentile": 1804.5, "90th_percentile": 1804.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 577.44, "10th_percentile": 577.44, "90th_percentile": 577.44, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 577.44, "10th_percentile": 577.44, "90th_percentile": 577.44, "count": "1 through 10" } ] } ] }, { "description": "Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 35.0, "minimum": 35.8875, "maximum": 112.2412, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.55, "10th_percentile": 44.55, "90th_percentile": 44.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 52.42 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 97.27, "10th_percentile": 97.27, "90th_percentile": 97.27, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.07 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 123.75, "10th_percentile": 123.75, "90th_percentile": 123.75, "count": "1 through 10" } ] } ] }, { "description": "MRI Ankle Arthro Left 73722", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2657.5, "discounted_cash": 770.0, "minimum": 770.675, "maximum": 2410.3525, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2086.66 } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "727", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 36560.016, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17481.88 } ] } ] }, { "description": "OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "845", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10039.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10039.5 } ] } ] }, { "description": "Arbovirus IgM Ab, CSF", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.5, "discounted_cash": 30.0, "minimum": 30.305, "maximum": 104.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2572.75, "10th_percentile": 2572.75, "90th_percentile": 2572.75, "count": "1 through 10" } ] } ] }, { "description": "Ionized Calcium", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.75, "discounted_cash": 54.0, "minimum": 54.7375, "maximum": 171.1962, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.95, "10th_percentile": 67.95, "90th_percentile": 67.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.19 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 64.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.4, "10th_percentile": 60.4, "90th_percentile": 60.4, "count": "1 through 10" } ] } ] }, { "description": "Factor X Activity", "code_information": [ { "code": "85260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.75, "discounted_cash": 95.0, "minimum": 95.3375, "maximum": 298.1762, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 } ] } ] }, { "description": "Trichinella IgG Ab", "code_information": [ { "code": "86784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 46.0, "minimum": 46.0375, "maximum": 143.9863, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.04 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 101.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.44 } ] } ] }, { "description": "Mycoplasma pneumoniae IgG", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 70.0, "minimum": 70.47, "maximum": 220.401, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.74 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 89728.698, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 17569.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15017.92, "10th_percentile": 15017.92, "90th_percentile": 15017.92, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31903.34 } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 72247.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72247.59 } ] } ] }, { "description": "MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "826", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 55146.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55146.49 } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITHOUT CCMCC", "code_information": [ { "code": "621", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 17782.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17782.5 } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 15598.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15598.0 } ] } ] }, { "description": "P jiro DFA", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 48.0, "minimum": 48.2125, "maximum": 150.7887, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.26 } ] } ] }, { "description": "IR Mech Removal Intracath OBS-CVAD", "code_information": [ { "code": "75902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.75, "discounted_cash": 302.0, "minimum": 302.9775, "maximum": 947.5883, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.16 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 12465.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12465.67 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITH MCC", "code_information": [ { "code": "974", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 34023.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34023.0 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC", "code_information": [ { "code": "690", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 19795.734, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9543.18 } ] } ] }, { "description": "CSF Oligoclonal Bands", "code_information": [ { "code": "83916", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 50.0, "minimum": 50.75, "maximum": 175.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 165.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 175.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 162.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.0 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 37147.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37147.08 } ] } ] }, { "description": "NM Thyroid Image w Uptake", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1016.25, "discounted_cash": 294.0, "minimum": 294.7125, "maximum": 1016.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 938.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 919.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1016.25 } ] } ] }, { "description": "CDM US 3D Imaging CPT 76376", "code_information": [ { "code": "76376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.25, "discounted_cash": 234.0, "minimum": 132.5548, "maximum": 732.1757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 274.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.55 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11657.0, "minimum": 11657.05, "maximum": 20122.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20122.61 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC", "code_information": [ { "code": "659", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 29954.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29954.62 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 18094.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18094.91 } ] } ] }, { "description": "HIV WITH MAJOR RELATED CONDITION WITHOUT CCMCC", "code_information": [ { "code": "976", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 10641.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10641.91 } ] } ] }, { "description": "IV Infusion Each Addl up to 8 Hr", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 93.0, "minimum": 93.96, "maximum": 293.868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 231.98, "10th_percentile": 231.98, "90th_percentile": 231.98, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 116.64, "10th_percentile": 116.64, "90th_percentile": 116.64, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.36, "10th_percentile": 112.36, "90th_percentile": 337.09, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.39, "10th_percentile": 75.49, "90th_percentile": 324.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 76.28, "10th_percentile": 38.14, "90th_percentile": 76.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 324.0, "10th_percentile": 324.0, "90th_percentile": 2592.0, "count": "44" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 207.36, "10th_percentile": 103.68, "90th_percentile": 440.64, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 293.87, "10th_percentile": 103.68, "90th_percentile": 829.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 207.36, "10th_percentile": 103.68, "90th_percentile": 1198.8, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 220.32, "10th_percentile": 103.68, "90th_percentile": 440.64, "count": "22" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 220.32, "10th_percentile": 103.68, "90th_percentile": 771.12, "count": "15" } ] } ] }, { "description": "Thiopurine Methyltransferase, RBC", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.75, "discounted_cash": 301.0, "minimum": 146.13, "maximum": 943.0533, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 146.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 223.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 153.5, "10th_percentile": 153.5, "90th_percentile": 153.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 332.72, "10th_percentile": 332.72, "90th_percentile": 332.72, "count": "1 through 10" } ] } ] }, { "description": "IR Hepatic Venogram wo Press 75891", "code_information": [ { "code": "75891", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6086.75, "discounted_cash": 1765.0, "minimum": 617.5646, "maximum": 5520.6822, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 827.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 617.56 } ] } ] }, { "description": "BURN TX SM FAC", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.5, "discounted_cash": 76.0, "minimum": 76.705, "maximum": 239.9015, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 264.5, "10th_percentile": 252.0, "90th_percentile": 264.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 239.9, "10th_percentile": 239.9, "90th_percentile": 239.9, "count": "1 through 10" } ] } ] }, { "description": "75825 FAC VEIN XRAY TRUNK", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6611.0, "discounted_cash": 1917.0, "minimum": 521.6826, "maximum": 5996.177, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 831.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1018.94 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 815.15 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.68 } ] } ] }, { "description": "INJ ANES TRIGEM FAC", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 905.75, "discounted_cash": 262.0, "minimum": 262.6675, "maximum": 821.5153, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 695.62, "10th_percentile": 695.62, "90th_percentile": 695.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 905.75, "10th_percentile": 862.5, "90th_percentile": 905.75, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 276.0, "10th_percentile": 276.0, "90th_percentile": 276.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 723.97, "10th_percentile": 723.97, "90th_percentile": 723.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 289.84, "10th_percentile": 289.84, "90th_percentile": 289.84, "count": "1 through 10" } ] } ] }, { "description": "CT Cervical Spine w Contrast", "code_information": [ { "code": "72126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.0, "discounted_cash": 755.0, "minimum": 650.0, "maximum": 2363.642, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1383.58 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1106.86 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 981.29 } ] } ] }, { "description": "ASP INJ INTERMED JT FAC", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.75, "discounted_cash": 102.0, "minimum": 102.8775, "maximum": 321.7582, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.03, "10th_percentile": 123.03, "90th_percentile": 123.03, "count": "1 through 10" } ] } ] }, { "description": "INT REP HAND FT 2.6-7.5 FAC", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 162.0, "minimum": 162.0375, "maximum": 506.7862, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.15, "10th_percentile": 201.15, "90th_percentile": 201.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 532.25, "10th_percentile": 532.25, "90th_percentile": 532.25, "count": "1 through 10" } ] } ] }, { "description": "XR Upper Extremity Infant 2 Views Left", "code_information": [ { "code": "73092", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.0, "discounted_cash": 125.0, "minimum": 77.24, "maximum": 393.638, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 77.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "99284 - Level 4 - Lynx Visit Level", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1569.5, "discounted_cash": 455.0, "minimum": 455.155, "maximum": 1569.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 977.16, "10th_percentile": 977.16, "90th_percentile": 977.16, "count": "16" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 565.02, "10th_percentile": 491.31, "90th_percentile": 565.02, "count": "49" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 1569.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 1569.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1569.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 544.3, "10th_percentile": 473.3, "90th_percentile": 544.3, "count": "83" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1364.75, "10th_percentile": 1364.75, "90th_percentile": 1364.75, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1093.3, "10th_percentile": 1093.3, "90th_percentile": 1233.63, "count": "23" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 1254.5, "10th_percentile": 1090.84, "90th_percentile": 2017.43, "count": "21" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1036.16, "10th_percentile": 348.13, "90th_percentile": 1569.5, "count": "153" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 635.79, "10th_percentile": 635.79, "90th_percentile": 1057.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1569.5, "10th_percentile": 1364.75, "90th_percentile": 1569.5, "count": "902" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "118" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1423.54, "10th_percentile": 1423.54, "90th_percentile": 1423.54, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 708.4, "count": "134" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "108" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 502.24, "10th_percentile": 436.72, "90th_percentile": 502.24, "count": "51" } ] } ] }, { "description": ".Beta 2 Glycoprotein IgG", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 32.0, "minimum": 32.335, "maximum": 111.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 334.5, "10th_percentile": 111.5, "90th_percentile": 334.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.84, "10th_percentile": 37.84, "90th_percentile": 37.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.68, "10th_percentile": 35.68, "90th_percentile": 35.68, "count": "1 through 10" } ] } ] }, { "description": "D-Dimer", "code_information": [ { "code": "85380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 149.75, "discounted_cash": 43.0, "minimum": 43.4275, "maximum": 135.8233, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 101.14, "10th_percentile": 101.14, "90th_percentile": 101.14, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.85, "10th_percentile": 50.85, "90th_percentile": 50.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.29 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.94, "10th_percentile": 48.99, "90th_percentile": 51.94, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 119.95, "10th_percentile": 115.82, "90th_percentile": 119.95, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 113.16, "10th_percentile": 113.16, "90th_percentile": 117.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.43, "10th_percentile": 26.91, "90th_percentile": 149.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 141.25, "10th_percentile": 141.25, "90th_percentile": 149.75, "count": "65" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.39, "10th_percentile": 47.92, "90th_percentile": 135.82, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 47.92, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.92, "10th_percentile": 45.2, "90th_percentile": 48.03, "count": "1 through 10" } ] } ] }, { "description": "KOH, Fluor", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.5, "discounted_cash": 30.0, "minimum": 30.015, "maximum": 93.8745, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 44.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 43.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.97 } ] } ] }, { "description": "SKIN ULCERS WITH MCC", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12777.0, "minimum": 12777.92, "maximum": 35512.293, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 12777.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3899.84, "10th_percentile": 3899.84, "90th_percentile": 3899.84, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22815.21 } ] } ] }, { "description": "XR Foreign Body Child 1 View", "code_information": [ { "code": "76010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 349.5, "discounted_cash": 101.0, "minimum": 72.92, "maximum": 316.9965, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 72.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 329.75, "10th_percentile": 329.75, "90th_percentile": 329.75, "count": "1 through 10" } ] } ] }, { "description": "IR Port Indwelling-Implantbl", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1791.25, "minimum": 519.4625, "maximum": 1624.6637, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1068.35, "10th_percentile": 1068.35, "90th_percentile": 1068.35, "count": "1 through 10" } ] } ] }, { "description": "Factor XI Activity", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 77.0, "minimum": 77.3575, "maximum": 241.9423, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 } ] } ] }, { "description": "KCl 40 MEQ/L (0.3%) in NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338069504", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "653", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21296.0, "minimum": 21296.53, "maximum": 61260.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61260.26 } ] } ] }, { "description": "Fungal Culture, Skin Hair Nails", "code_information": [ { "code": "87101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 48.0, "minimum": 48.9375, "maximum": 153.0563, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.48 } ] } ] }, { "description": "NM Venous Thrombosis Bilateral", "code_information": [ { "code": "78458", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 256.0, "minimum": 256.215, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 644.8 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 790.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 632.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 } ] } ] }, { "description": "88334 AP Bill Cytologic Exam Additional Site", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 28.0, "minimum": 28.855, "maximum": 99.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "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": 3138.0, "minimum": 3138.44, "maximum": 14244.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14244.62 } ] } ] }, { "description": "Rotavirus Antigen, Stool", "code_information": [ { "code": "87425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.25, "discounted_cash": 83.0, "minimum": 83.5925, "maximum": 261.4427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 51786.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51786.63 } ] } ] }, { "description": "US Spinal Canal", "code_information": [ { "code": "76800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 637.25, "discounted_cash": 184.0, "minimum": 184.8025, "maximum": 637.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 270.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 637.25 } ] } ] }, { "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "Protein, Body Fluid", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 23.0, "minimum": 23.49, "maximum": 73.467, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.09, "10th_percentile": 28.09, "90th_percentile": 28.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.92, "10th_percentile": 25.92, "90th_percentile": 25.92, "count": "1 through 10" } ] } ] }, { "description": "17-Hydroxyprogesterone Quantitative - 83498 - 3358335 - 3358335", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.25, "discounted_cash": 63.0, "minimum": 63.8725, "maximum": 220.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 220.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 219.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 220.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 199.77, "10th_percentile": 199.77, "90th_percentile": 199.77, "count": "1 through 10" } ] } ] }, { "description": "Rubella Antibody, IgG", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 26.0, "minimum": 26.4625, "maximum": 91.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 86.0, "10th_percentile": 86.0, "90th_percentile": 91.25, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.78, "10th_percentile": 78.78, "90th_percentile": 82.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.2, "10th_percentile": 29.2, "90th_percentile": 29.2, "count": "1 through 10" } ] } ] }, { "description": "XR Facial Bones 1-2 Views", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.0, "discounted_cash": 89.0, "minimum": 80.1, "maximum": 279.356, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 191.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 290.5, "10th_percentile": 290.5, "90th_percentile": 290.5, "count": "1 through 10" } ] } ] }, { "description": "OTElectrical Stim (Unattended) - Non-Wound - 97014 - 4520006", "code_information": [ { "code": "97014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 18.0, "minimum": 18.705, "maximum": 64.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 8274.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8274.69 } ] } ] }, { "description": "MRI Femur Left w Contrast", "code_information": [ { "code": "73719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 626.0, "minimum": 626.11, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1649.59 } ] } ] }, { "description": "Bill Celiac Plus HLA-DQA1", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 860.75, "discounted_cash": 249.0, "minimum": 249.6175, "maximum": 860.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 555.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 544.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 860.75 } ] } ] }, { "description": "Lacosamide (Vimpat) Level", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 699.5, "discounted_cash": 202.0, "minimum": 46.3525, "maximum": 634.4465, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 } ] } ] }, { "description": "NM Thyroid Mets Image Limited", "code_information": [ { "code": "78015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1218.75, "discounted_cash": 353.0, "minimum": 353.4375, "maximum": 1218.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 675.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 827.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 662.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1218.75 } ] } ] }, { "description": "NM Shunt Peritoneal Venous Patent", "code_information": [ { "code": "78291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 837.0, "discounted_cash": 242.0, "minimum": 242.73, "maximum": 837.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 773.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 837.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 757.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 837.0 } ] } ] }, { "description": "Echo 3D Recon w Post Proc on WS", "code_information": [ { "code": "76377", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 807.25, "discounted_cash": 234.0, "minimum": 234.1025, "maximum": 732.1757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 291.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 357.51 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 286.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 343.99 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 48731.049, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21550.26 } ] } ] }, { "description": "Chlamydia Culture", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 71.0, "minimum": 71.195, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 161.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 158.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.7 } ] } ] }, { "description": "NM Lung VQ Scan", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1461.25, "discounted_cash": 423.0, "minimum": 423.7625, "maximum": 1461.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1100.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1347.94 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1078.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1461.25 } ] } ] }, { "description": "PSA, Free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.0, "discounted_cash": 93.0, "minimum": 93.38, "maximum": 292.054, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.92, "10th_percentile": 115.92, "90th_percentile": 115.92, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.67, "10th_percentile": 111.67, "90th_percentile": 111.67, "count": "1 through 10" }, { "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": 170.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.26, "10th_percentile": 109.48, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 322.0, "10th_percentile": 322.0, "90th_percentile": 322.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.04, "10th_percentile": 93.38, "90th_percentile": 103.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 292.05, "10th_percentile": 292.05, "90th_percentile": 292.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.04, "10th_percentile": 103.04, "90th_percentile": 103.04, "count": "1 through 10" } ] } ] }, { "description": "Differential WBC", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.75, "discounted_cash": 8.0, "minimum": 8.9175, "maximum": 30.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.75 } ] } ] }, { "description": "XR Thoracic Spine AP+Lateral", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 486.75, "discounted_cash": 141.0, "minimum": 88.66, "maximum": 441.4823, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 373.82, "10th_percentile": 373.82, "90th_percentile": 373.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.33, "10th_percentile": 165.33, "90th_percentile": 175.23, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 88.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 159.27, "10th_percentile": 159.27, "90th_percentile": 159.27, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 292.54, "10th_percentile": 292.54, "90th_percentile": 292.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 197.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 155.76, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 459.25, "10th_percentile": 459.25, "90th_percentile": 486.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 146.96, "90th_percentile": 155.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 441.48, "10th_percentile": 420.67, "90th_percentile": 441.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.76, "10th_percentile": 155.76, "90th_percentile": 169.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 146.96, "10th_percentile": 146.96, "90th_percentile": 156.15, "count": "1 through 10" } ] } ] }, { "description": "IR Drainage Cath Placement 75989", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2201.25, "discounted_cash": 638.0, "minimum": 330.33, "maximum": 1996.5338, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 330.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 482.21 } ] } ] }, { "description": "Copper, Serum", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 31.0, "minimum": 31.61, "maximum": 109.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 78.04, "10th_percentile": 78.04, "90th_percentile": 78.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.41 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 87.32, "10th_percentile": 85.67, "90th_percentile": 87.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 109.0, "10th_percentile": 109.0, "90th_percentile": 109.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.88, "10th_percentile": 34.88, "90th_percentile": 34.88, "count": "1 through 10" } ] } ] }, { "description": "CT Guided Tissue Ablation", "code_information": [ { "code": "77013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.0, "discounted_cash": 110.0, "minimum": 110.49, "maximum": 381.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 381.0 }, { "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": "Multiple Level Spinal Fusion Except Cervical without MCC", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 49994.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49994.71 } ] } ] }, { "description": "EP Interp", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.5, "discounted_cash": 63.0, "minimum": 63.945, "maximum": 199.9935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 180.38 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 144.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.83, "10th_percentile": 17.83, "90th_percentile": 17.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 77.7, "10th_percentile": 77.7, "90th_percentile": 77.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.2, "10th_percentile": 67.2, "90th_percentile": 67.2, "count": "1 through 10" } ] } ] }, { "description": "I-D ABSCESS COMPLEX FAC", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 162.0, "minimum": 162.0375, "maximum": 506.7862, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 193.78, "10th_percentile": 193.78, "90th_percentile": 193.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 558.75, "10th_percentile": 558.75, "90th_percentile": 558.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 506.79, "10th_percentile": 506.79, "90th_percentile": 506.79, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 178.8, "10th_percentile": 178.8, "90th_percentile": 178.8, "count": "1 through 10" } ] } ] }, { "description": "XR Abdomen 3+ Views 74021", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 178.0, "minimum": 103.39, "maximum": 558.0317, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 196.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 157.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITH MCC", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 25000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25000.89 } ] } ] }, { "description": "U Cyc AMP", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 319.75, "discounted_cash": 92.0, "minimum": 92.7275, "maximum": 290.0133, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 212.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.94 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 208.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.18 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 30448.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30448.58 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 22817.691, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 7730.65, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 25352.99, "10th_percentile": 25352.99, "90th_percentile": 25352.99, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12451.52 } ] } ] }, { "description": "XR Small Bowel Series", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1010.0, "discounted_cash": 292.0, "minimum": 292.9, "maximum": 916.07, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 363.6, "10th_percentile": 363.6, "90th_percentile": 363.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 307.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 377.18 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 301.74 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.58 } ] } ] }, { "description": "CT Panc Mass Protocol abd only", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3122.5, "discounted_cash": 905.0, "minimum": 650.0, "maximum": 2832.1075, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "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": 1722.87 } ] } ] }, { "description": "zzMaternal Serum Screen, Integrated Spec 1", "code_information": [ { "code": "84163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.75, "discounted_cash": 58.0, "minimum": 58.2175, "maximum": 182.0803, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 } ] } ] }, { "description": "Strep pneumoniae 7F IgG", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.0, "discounted_cash": 30.0, "minimum": 30.45, "maximum": 105.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 105.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.0 } ] } ] }, { "description": "US Doppler Echocard Fetal Pulse", "code_information": [ { "code": "76827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.75, "discounted_cash": 189.0, "minimum": 173.04, "maximum": 593.8582, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 173.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.92 } ] } ] }, { "description": "US Pelvis Complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 944.5, "discounted_cash": 273.0, "minimum": 273.905, "maximum": 856.6615, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 340.02, "10th_percentile": 340.02, "90th_percentile": 340.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 421.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 337.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 327.55, "10th_percentile": 309.0, "90th_percentile": 327.55, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 601.65, "10th_percentile": 601.65, "90th_percentile": 601.65, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 742.38, "10th_percentile": 713.78, "90th_percentile": 742.38, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.08, "10th_percentile": 486.08, "90th_percentile": 823.68, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 690.53, "10th_percentile": 690.53, "90th_percentile": 690.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 944.5, "10th_percentile": 891.0, "90th_percentile": 944.5, "count": "46" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 816.16, "10th_percentile": 302.24, "90th_percentile": 816.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 285.12, "90th_percentile": 329.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.24, "10th_percentile": 302.24, "90th_percentile": 302.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 637.96, "10th_percentile": 637.96, "90th_percentile": 637.96, "count": "1 through 10" } ] } ] }, { "description": "Potassium Serum", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.75, "discounted_cash": 8.0, "minimum": 8.6275, "maximum": 29.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.71, "10th_percentile": 10.71, "90th_percentile": 10.71, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.32, "10th_percentile": 10.32, "90th_percentile": 10.32, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 18.95, "10th_percentile": 18.95, "90th_percentile": 18.95, "count": "1 through 10" }, { "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.75, "10th_percentile": 29.75, "90th_percentile": 29.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.75, "10th_percentile": 29.75, "90th_percentile": 29.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.63, "10th_percentile": 8.63, "90th_percentile": 8.63, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 11.66, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.52, "10th_percentile": 9.52, "90th_percentile": 9.52, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC", "code_information": [ { "code": "823", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22641.0, "minimum": 22641.57, "maximum": 54050.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54050.12 } ] } ] }, { "description": "Neutral Fat, Fecal", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.75, "discounted_cash": 41.0, "minimum": 41.1075, "maximum": 128.5673, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.1, "10th_percentile": 5.1, "90th_percentile": 5.1, "count": "1 through 10" } ] } ] }, { "description": "IHC ERA Quant 88360 AP Bill", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 144.0, "minimum": 144.275, "maximum": 497.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.89, "10th_percentile": 307.89, "90th_percentile": 307.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 497.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.48, "10th_percentile": 114.48, "90th_percentile": 114.48, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 26783.38, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26783.38 } ] } ] }, { "description": "XR Thoracolumbar Spine AP+Lateral", "code_information": [ { "code": "72080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 511.75, "discounted_cash": 148.0, "minimum": 94.37, "maximum": 464.1572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.79, "10th_percentile": 173.79, "90th_percentile": 173.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 511.75, "10th_percentile": 511.75, "90th_percentile": 511.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 154.47, "10th_percentile": 154.47, "90th_percentile": 154.47, "count": "1 through 10" } ] } ] }, { "description": "XR Ribs Bilateral wo Chest Film", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 551.0, "discounted_cash": 159.0, "minimum": 107.26, "maximum": 499.757, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.57 } ] } ] }, { "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": 5828.0, "minimum": 5828.52, "maximum": 12338.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12338.35 } ] } ] }, { "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": 11657.0, "minimum": 11657.05, "maximum": 26028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26028.89 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12901.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12901.86 } ] } ] }, { "description": "MRI Implant initial 15 minutes 76014", "code_information": [ { "code": "76014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 21.0, "minimum": 21.315, "maximum": 73.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.5 } ] } ] }, { "description": "Atypical P-ANCA Titer", "code_information": [ { "code": "86021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 15.0, "minimum": 15.37, "maximum": 53.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 38.75, "10th_percentile": 38.75, "90th_percentile": 38.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 16.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 48.07, "10th_percentile": 48.07, "90th_percentile": 48.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.96, "10th_percentile": 16.96, "90th_percentile": 16.96, "count": "1 through 10" } ] } ] }, { "description": "Lidocaine HCl (Cardiac) IV Soln 100 MG/5ML (2%)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00409132315", "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "SLP Swallow Dysfunction Oral Feed Units", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 348.25, "discounted_cash": 100.0, "minimum": 95.0, "maximum": 315.8628, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 348.25, "10th_percentile": 348.25, "90th_percentile": 348.25, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH MCC", "code_information": [ { "code": "796", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 13757.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13757.74 } ] } ] }, { "description": "Pneumococcal Vaccine Polyvalent Soln Pref Syr 25 MCG/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00006483703", "type": "NDC" }, { "code": "90732", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.67, "10th_percentile": 168.67, "90th_percentile": 168.67, "count": "1 through 10" } ] } ] }, { "description": "Rheumatoid Factor", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.75, "discounted_cash": 38.0, "minimum": 38.4975, "maximum": 120.4043, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 89.68, "10th_percentile": 89.68, "90th_percentile": 89.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.79, "10th_percentile": 47.79, "90th_percentile": 47.79, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.44, "10th_percentile": 43.44, "90th_percentile": 46.04, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 79.78, "10th_percentile": 79.78, "90th_percentile": 79.78, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 100.34, "10th_percentile": 100.34, "90th_percentile": 104.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.25, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 97.07, "10th_percentile": 97.07, "90th_percentile": 97.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 125.25, "10th_percentile": 125.25, "90th_percentile": 132.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.48, "10th_percentile": 40.08, "90th_percentile": 42.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 120.4, "10th_percentile": 46.34, "90th_percentile": 120.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.48, "10th_percentile": 40.08, "90th_percentile": 46.34, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 42.59, "count": "1 through 10" } ] } ] }, { "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": 76.8, "median_amount": 126.67, "10th_percentile": 126.67, "90th_percentile": 126.67, "count": "1 through 10" } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 37458.31, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37458.31 } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 25729.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25729.45 } ] } ] }, { "description": "PREMATURITY WITHOUT MAJOR PROBLEMS", "code_information": [ { "code": "792", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 28873.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28873.57 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT NEOPLASMS WITH CC", "code_information": [ { "code": "687", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 12352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12352.49 } ] } ] }, { "description": "HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC", "code_information": [ { "code": "970", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 31092.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31092.26 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "737", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 24292.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24292.37 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 11820.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11820.81 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH CC", "code_information": [ { "code": "902", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 22570.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22570.0 } ] } ] }, { "description": "MTB MIC", "code_information": [ { "code": "87188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.25, "discounted_cash": 14.0, "minimum": 14.5725, "maximum": 50.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 50.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 50.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.25 } ] } ] }, { "description": "Haptoglob", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.25, "discounted_cash": 44.0, "minimum": 44.1525, "maximum": 138.0908, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 127.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 101.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.62 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 152.25, "10th_percentile": 152.25, "90th_percentile": 152.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 51.77, "count": "1 through 10" } ] } ] }, { "description": "DISTAL RADIAL FX MAN FAC", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.25, "discounted_cash": 219.0, "minimum": 219.3125, "maximum": 685.9188, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 272.25, "10th_percentile": 272.25, "90th_percentile": 272.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 262.27, "10th_percentile": 262.27, "90th_percentile": 262.27, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 720.25, "10th_percentile": 720.25, "90th_percentile": 756.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 242.0, "10th_percentile": 242.0, "90th_percentile": 242.0, "count": "1 through 10" } ] } ] }, { "description": "Trypsin Level", "code_information": [ { "code": "84490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 16.0, "minimum": 16.095, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 } ] } ] }, { "description": "SLP Team Conference 30 Min Non Physician Unit", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.0, "discounted_cash": 38.0, "minimum": 38.57, "maximum": 120.631, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Spine Procedure", "code_information": [ { "code": "22899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 512.5, "discounted_cash": 148.0, "minimum": 148.625, "maximum": 512.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 512.5 } ] } ] }, { "description": "REHABILITATION WITH CCMCC", "code_information": [ { "code": "945", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 18256.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18256.41 } ] } ] }, { "description": "Bill Chr Anal CLL Cytogenetics", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.25, "discounted_cash": 285.0, "minimum": 285.7225, "maximum": 893.6218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 324.96 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 474.56 } ] } ] }, { "description": "74177 FAC CT ABD PELVIS W CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2767.25, "discounted_cash": 802.0, "minimum": 650.0, "maximum": 2509.8958, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1696.74, "10th_percentile": 1696.74, "90th_percentile": 1696.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 853.11, "10th_percentile": 853.11, "90th_percentile": 904.32, "count": "19" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1322.81 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1058.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.16, "10th_percentile": 821.83, "90th_percentile": 871.16, "count": "39" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1974.43, "10th_percentile": 1898.41, "90th_percentile": 1974.43, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1914.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 805.72, "10th_percentile": 673.32, "90th_percentile": 1529.16, "count": "16" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 544.25, "10th_percentile": 544.25, "90th_percentile": 544.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2512.0, "10th_percentile": 2369.75, "90th_percentile": 2512.0, "count": "198" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 805.72, "count": "114" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 876.81, "10th_percentile": 758.32, "90th_percentile": 2278.38, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 876.81, "count": "56" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 803.84, "90th_percentile": 805.72, "count": "61" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 803.84, "10th_percentile": 758.32, "90th_percentile": 805.72, "count": "37" } ] } ] }, { "description": "Vitamin B6 (Pyridoxal 5-Phosphate)", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.0, "discounted_cash": 149.0, "minimum": 149.35, "maximum": 467.105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 224.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 274.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 219.84 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 404.79, "10th_percentile": 404.79, "90th_percentile": 404.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 260.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 346.74, "10th_percentile": 346.74, "90th_percentile": 346.74, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 119.71, "10th_percentile": 119.71, "90th_percentile": 119.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 515.0, "10th_percentile": 515.0, "90th_percentile": 515.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.8, "10th_percentile": 164.8, "90th_percentile": 164.8, "count": "1 through 10" } ] } ] }, { "description": "CEA, Peritoneal Fluid", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.0, "discounted_cash": 68.0, "minimum": 68.73, "maximum": 214.959, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 156.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 191.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 153.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.19, "10th_percentile": 82.19, "90th_percentile": 82.19, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 176.17, "10th_percentile": 74.26, "90th_percentile": 237.0, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 237.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 214.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 75.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.84, "10th_percentile": 75.84, "90th_percentile": 80.58, "count": "1 through 10" } ] } ] }, { "description": "MRI Forearm Left wo Contrast", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1868.75, "discounted_cash": 541.0, "minimum": 541.9375, "maximum": 1868.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1468.84, "10th_percentile": 1468.84, "90th_percentile": 1468.84, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1868.75 } ] } ] }, { "description": "Fluoxetine Level", "code_information": [ { "code": "80332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 26.0, "minimum": 26.4625, "maximum": 91.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 } ] } ] }, { "description": "SO KRAS Mutation Detect2", "code_information": [ { "code": "81276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 791.5, "discounted_cash": 229.0, "minimum": 229.535, "maximum": 791.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 791.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 791.5 } ] } ] }, { "description": "UGT1A1 Gene Polymorphism (TA Repeat)", "code_information": [ { "code": "81350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.5, "discounted_cash": 191.0, "minimum": 191.545, "maximum": 660.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 228.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 224.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 660.5 } ] } ] }, { "description": "KIDNEY TRANSPLANT", "code_information": [ { "code": "652", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 38072.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38072.51 } ] } ] }, { "description": "COMPLEX EXT 2.6-7.5 FAC", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1462.25, "discounted_cash": 424.0, "minimum": 424.0525, "maximum": 1326.2607, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1392.5, "10th_percentile": 1392.5, "90th_percentile": 1392.5, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 6413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6413.21 } ] } ] }, { "description": "HCV Genosure", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1081.25, "discounted_cash": 313.0, "minimum": 313.5625, "maximum": 1081.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1075.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1081.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1054.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1081.25 } ] } ] }, { "description": "Methylprednisolone Sod Succ For Inj PF 40 MG (Base Equiv)", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "00009003930", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" } ] } ] }, { "description": "5HIAA, Urine Random", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.25, "discounted_cash": 42.0, "minimum": 42.7025, "maximum": 133.5557, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 147.25, "10th_percentile": 147.25, "90th_percentile": 147.25, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITH CC", "code_information": [ { "code": "797", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 11793.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11793.7 } ] } ] }, { "description": "Chemo IV Push Each Addl Subsequent", "code_information": [ { "code": "96411", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.0, "discounted_cash": 83.0, "minimum": 83.52, "maximum": 261.216, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 184.44, "10th_percentile": 147.54, "90th_percentile": 184.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 199.76, "10th_percentile": 199.76, "90th_percentile": 199.76, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 576.0, "10th_percentile": 576.0, "90th_percentile": 576.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 548.5, "10th_percentile": 274.25, "90th_percentile": 576.0, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 184.32, "10th_percentile": 20.29, "90th_percentile": 184.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 92.16, "90th_percentile": 92.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.16, "10th_percentile": 87.76, "90th_percentile": 93.25, "count": "11" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 27062.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27062.78 } ] } ] }, { "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": 9191.0, "minimum": 9191.13, "maximum": 16796.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16796.94 } ] } ] }, { "description": "MRI Angio Head wo Contrast", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1925.5, "discounted_cash": 558.0, "minimum": 558.395, "maximum": 1746.4285, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1542.52, "10th_percentile": 1542.52, "90th_percentile": 1542.52, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.42 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1925.5, "10th_percentile": 1925.5, "90th_percentile": 1925.5, "count": "1 through 10" } ] } ] }, { "description": "Carbamazepine Level", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.25, "discounted_cash": 55.0, "minimum": 55.4625, "maximum": 173.4638, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.85, "10th_percentile": 68.85, "90th_percentile": 68.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 117.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.15, "10th_percentile": 114.15, "90th_percentile": 114.15, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.2, "10th_percentile": 57.76, "90th_percentile": 61.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.2, "10th_percentile": 61.2, "90th_percentile": 61.2, "count": "1 through 10" } ] } ] }, { "description": "IR Hepatic Venogram w PRES 75889", "code_information": [ { "code": "75889", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7514.0, "discounted_cash": 2179.0, "minimum": 611.8963, "maximum": 6815.198, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1035.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 827.99 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.9 } ] } ] }, { "description": "Triiodothyronine, Total (T3)", "code_information": [ { "code": "84480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.5, "discounted_cash": 45.0, "minimum": 45.095, "maximum": 143.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.98, "10th_percentile": 55.98, "90th_percentile": 55.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 114.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.93, "10th_percentile": 53.93, "90th_percentile": 53.93, "count": "1 through 10" }, { "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": 99.05, "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": 78.6, "median_amount": 122.22, "10th_percentile": 122.22, "90th_percentile": 122.22, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 155.5, "10th_percentile": 155.5, "90th_percentile": 155.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 52.87, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 141.04, "10th_percentile": 49.76, "90th_percentile": 141.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 49.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.87, "10th_percentile": 52.87, "90th_percentile": 52.87, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.76, "10th_percentile": 49.76, "90th_percentile": 52.87, "count": "1 through 10" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITHOUT MCC", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10077.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10077.22 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 25236.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25236.67 } ] } ] }, { "description": "NM Renal Scan w Flow", "code_information": [ { "code": "78701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.5, "discounted_cash": 182.0, "minimum": 182.845, "maximum": 630.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 630.5 } ] } ] }, { "description": "SO KRAS Mutation Detection", "code_information": [ { "code": "88381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 566.0, "discounted_cash": 164.0, "minimum": 164.14, "maximum": 566.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 566.0 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 10896.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10896.55 } ] } ] }, { "description": "XR Cervical Spine Flex+Ext+Obl", "code_information": [ { "code": "72052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 684.75, "discounted_cash": 198.0, "minimum": 183.03, "maximum": 621.0683, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 186.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 183.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 408.86 } ] } ] }, { "description": "Cardiac Rehab Phase II w/ tele", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.25, "discounted_cash": 37.0, "minimum": 37.1925, "maximum": 116.3227, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.04, "10th_percentile": 41.04, "90th_percentile": 41.04, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28021.0, "minimum": 28021.75, "maximum": 75858.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75858.55 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 20153.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20153.26 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 9070.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9070.44 } ] } ] }, { "description": "PT Evaluation Units, Moderate Complexity", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 122.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 420.75, "10th_percentile": 420.75, "90th_percentile": 420.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 31.14, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "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": 7397.0, "minimum": 7397.74, "maximum": 11250.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11250.22 } ] } ] }, { "description": "Hepatitis A Antibodies,Total", "code_information": [ { "code": "86708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 43.0, "minimum": 43.065, "maximum": 134.6895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 100.24, "10th_percentile": 100.24, "90th_percentile": 100.24, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.55, "10th_percentile": 48.55, "90th_percentile": 48.55, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 94.59, "10th_percentile": 94.59, "90th_percentile": 94.59, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 112.15, "10th_percentile": 112.15, "90th_percentile": 116.72, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.86 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 140.0, "10th_percentile": 140.0, "90th_percentile": 148.5, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 47.52, "10th_percentile": 47.52, "90th_percentile": 47.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.8, "10th_percentile": 44.8, "90th_percentile": 47.52, "count": "1 through 10" } ] } ] }, { "description": "US Infant Hips Dynamic", "code_information": [ { "code": "76885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.5, "discounted_cash": 104.0, "minimum": 104.255, "maximum": 359.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 309.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 247.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.5 } ] } ] }, { "description": "EXC NAIL MATRIX FAC", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1901.5, "discounted_cash": 551.0, "minimum": 551.435, "maximum": 1724.6605, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1901.5, "10th_percentile": 1901.5, "90th_percentile": 1901.5, "count": "1 through 10" } ] } ] }, { "description": "NM Lymphoscinitigraphy", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1184.5, "discounted_cash": 343.0, "minimum": 343.505, "maximum": 1184.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1062.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1184.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1041.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1184.5 } ] } ] }, { "description": "XR Femur Right Min 2 Views", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 100.0, "minimum": 100.05, "maximum": 312.915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 252.26, "10th_percentile": 252.26, "90th_percentile": 252.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.2, "10th_percentile": 117.18, "90th_percentile": 124.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.65, "10th_percentile": 119.65, "90th_percentile": 119.65, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 345.0, "10th_percentile": 345.0, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 325.5, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.4, "count": "1 through 10" } ] } ] }, { "description": "CT Bone Length Study", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 735.5, "discounted_cash": 213.0, "minimum": 94.37, "maximum": 667.0985, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 273.51 } ] } ] }, { "description": "XR Optic Foramina", "code_information": [ { "code": "70190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 694.75, "discounted_cash": 201.0, "minimum": 97.22, "maximum": 630.1382, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 99.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.53 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 97.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.37 } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 10765.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10765.7 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 64041.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64041.28 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "817", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 26897.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26897.74 } ] } ] }, { "description": "$ Clostridum difficile A+B", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 62.0, "minimum": 62.7125, "maximum": 196.1387, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 } ] } ] }, { "description": "KIDNEY AND URINARY TRACT INFECTIONS WITH MCC", "code_information": [ { "code": "689", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 17535.8047, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8518.61, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13678.75 } ] } ] }, { "description": "SALIVARY GLAND PROCEDURES", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 14567.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14567.64 } ] } ] }, { "description": "XR IVP", "code_information": [ { "code": "74400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1625.25, "discounted_cash": 471.0, "minimum": 331.76, "maximum": 1474.1018, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 338.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 414.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 331.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 947.41 } ] } ] }, { "description": "MMRI Breast BX Left EA Add Lesion 19086", "code_information": [ { "code": "19086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4684.5, "discounted_cash": 1358.0, "minimum": 900.0, "maximum": 4248.8415, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "Computer XM OK - XM Electronic Interp", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.0, "discounted_cash": 22.0, "minimum": 22.33, "maximum": 77.0, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.18, "10th_percentile": 24.64, "90th_percentile": 49.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.72, "10th_percentile": 27.72, "90th_percentile": 110.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 49.31, "10th_percentile": 49.31, "90th_percentile": 98.62, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.7, "10th_percentile": 26.7, "90th_percentile": 53.41, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 49.05, "10th_percentile": 49.05, "90th_percentile": 49.05, "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": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.0, "10th_percentile": 77.0, "90th_percentile": 77.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 154.0, "10th_percentile": 77.0, "90th_percentile": 231.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.18, "10th_percentile": 24.64, "90th_percentile": 52.36, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.64, "10th_percentile": 24.64, "90th_percentile": 24.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.64, "10th_percentile": 24.64, "90th_percentile": 49.28, "count": "1 through 10" } ] } ] }, { "description": "MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CCMCC", "code_information": [ { "code": "760", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11877.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11877.4 } ] } ] }, { "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": 76.8, "median_amount": 150.42, "10th_percentile": 46.15, "90th_percentile": 418.56, "count": "1 through 10" } ] } ] }, { "description": "NM Thyroid Therapy Hyperthyroid", "code_information": [ { "code": "79005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 477.5, "discounted_cash": 138.0, "minimum": 138.475, "maximum": 434.2688, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 248.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 434.27 } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "755", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 12824.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12824.05 } ] } ] }, { "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": 4259.0, "minimum": 4259.31, "maximum": 23904.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23904.51 } ] } ] }, { "description": "NM Cerebrospinal Imaging Ventriculograph", "code_information": [ { "code": "78635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 287.0, "minimum": 287.1, "maximum": 990.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 } ] } ] }, { "description": "NM Spleen Scan", "code_information": [ { "code": "78185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.5, "discounted_cash": 182.0, "minimum": 182.845, "maximum": 630.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 630.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 630.5 } ] } ] }, { "description": "NM Brain Imaging Complete", "code_information": [ { "code": "78605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 406.0, "minimum": 406.5075, "maximum": 1361.9474, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 656.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 804.42 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 643.54 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1361.95 } ] } ] }, { "description": "NM Exametazim/Ceretec", "code_information": [ { "code": "A9521", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2011.0, "minimum": 583.19, "maximum": 2011.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2011.0 } ] } ] }, { "description": "SPINAL DISORDERS AND INJURIES WITHOUT CCMCC", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11543.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11543.77 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH MCC", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 42097.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42097.27 } ] } ] }, { "description": "36593 DECLOT VASCLR DEV", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.0, "discounted_cash": 255.0, "minimum": 255.78, "maximum": 799.974, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 302.4, "10th_percentile": 302.4, "90th_percentile": 302.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 268.8, "10th_percentile": 268.8, "90th_percentile": 285.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 564.48, "10th_percentile": 282.24, "90th_percentile": 564.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.24, "10th_percentile": 282.24, "90th_percentile": 282.24, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 285.6, "10th_percentile": 285.6, "90th_percentile": 285.6, "count": "1 through 10" } ] } ] }, { "description": "Covid-19 Ag", "code_information": [ { "code": "87811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 14.0, "minimum": 14.5, "maximum": 50.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 28.97, "10th_percentile": 28.97, "90th_percentile": 28.97, "count": "1 through 10" } ] } ] }, { "description": "SO EGFR Mutation", "code_information": [ { "code": "81235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2102.5, "discounted_cash": 609.0, "minimum": 609.725, "maximum": 2102.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2102.5 } ] } ] }, { "description": "XM AHG Interp (Automated)", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 59.0, "minimum": 59.16, "maximum": 204.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 130.56, "10th_percentile": 130.56, "90th_percentile": 130.56, "count": "1 through 10" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "654", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 33000.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33000.89 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 35088.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35088.72 } ] } ] }, { "description": "Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 48.0, "minimum": 48.865, "maximum": 152.8295, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 120.65, "10th_percentile": 120.65, "90th_percentile": 120.65, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.66, "10th_percentile": 60.66, "90th_percentile": 60.66, "count": "25" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.44, "10th_percentile": 58.44, "90th_percentile": 58.44, "count": "32" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 107.33, "10th_percentile": 107.33, "90th_percentile": 107.33, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 132.44, "10th_percentile": 132.44, "90th_percentile": 134.99, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 126.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.62, "10th_percentile": 57.29, "90th_percentile": 168.5, "count": "23" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 39.17, "10th_percentile": 39.17, "90th_percentile": 129.41, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.5, "10th_percentile": 168.5, "90th_percentile": 168.5, "count": "148" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 48.87, "90th_percentile": 57.29, "count": "94" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 134.68, "10th_percentile": 53.92, "90th_percentile": 154.35, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 62.35, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 57.29, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 57.29, "count": "36" } ] } ] }, { "description": "96367 IV INF NONCHEM EA", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.25, "discounted_cash": 74.0, "minimum": 74.3125, "maximum": 232.4187, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 164.1, "10th_percentile": 164.1, "90th_percentile": 492.31, "count": "28" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.87, "10th_percentile": 88.87, "90th_percentile": 177.74, "count": "13" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 256.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 256.25, "10th_percentile": 256.25, "90th_percentile": 512.5, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 87.13, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.81, "10th_percentile": 82.0, "90th_percentile": 164.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.0, "10th_percentile": 82.0, "90th_percentile": 246.0, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.13, "10th_percentile": 82.0, "90th_percentile": 174.25, "count": "1 through 10" } ] } ] }, { "description": "LIVER TRANSPLANT WITHOUT MCC", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 54665.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54665.5 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITH CCMCC", "code_information": [ { "code": "904", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14795.0, "minimum": 14795.48, "maximum": 43302.1, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43302.1 } ] } ] }, { "description": "OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5614.5351, "maximum": 11356.32, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11356.32 } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 40219.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40219.28 } ] } ] }, { "description": "$ COVID/FLU/RSV Combo", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600.5, "discounted_cash": 174.0, "minimum": 174.145, "maximum": 600.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.5 } ] } ] }, { "description": "PT Manual Therapy Units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.25, "discounted_cash": 60.0, "minimum": 60.9725, "maximum": 190.6968, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Thyroxine Binding Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.5, "discounted_cash": 48.0, "minimum": 48.865, "maximum": 152.8295, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 122.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 119.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.92, "10th_percentile": 53.92, "90th_percentile": 53.92, "count": "1 through 10" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 11541.41, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11541.41 } ] } ] }, { "description": "MRI Chest w Contrast", "code_information": [ { "code": "71551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 626.0, "minimum": 626.11, "maximum": 2159.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2159.0 } ] } ] }, { "description": "Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.75, "discounted_cash": 36.0, "minimum": 36.7575, "maximum": 114.9622, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.62 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 86.89 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 101.54, "10th_percentile": 101.54, "90th_percentile": 101.54, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 126.75, "10th_percentile": 126.75, "90th_percentile": 126.75, "count": "1 through 10" } ] } ] }, { "description": "CSF Glucose", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.0, "discounted_cash": 16.0, "minimum": 16.53, "maximum": 51.699, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.77, "10th_percentile": 19.77, "90th_percentile": 19.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.24, "10th_percentile": 18.24, "90th_percentile": 18.24, "count": "1 through 10" } ] } ] }, { "description": "Procainamide Level", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 48.0, "minimum": 48.9375, "maximum": 168.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 168.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.28 } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITH MCC", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 58324.8, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58324.8 } ] } ] }, { "description": "99283 - Level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 859.25, "discounted_cash": 249.0, "minimum": 249.1825, "maximum": 859.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 535.03, "10th_percentile": 535.03, "90th_percentile": 535.03, "count": "21" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 309.33, "10th_percentile": 269.01, "90th_percentile": 309.33, "count": "59" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 859.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 859.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 859.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 297.99, "10th_percentile": 259.15, "90th_percentile": 297.99, "count": "81" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 321.54, "10th_percentile": 219.3, "90th_percentile": 608.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 598.62, "10th_percentile": 598.62, "90th_percentile": 675.37, "count": "31" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 686.8, "10th_percentile": 686.8, "90th_percentile": 686.8, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 345.76, "10th_percentile": 71.22, "90th_percentile": 747.25, "count": "174" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 579.12, "10th_percentile": 535.03, "90th_percentile": 659.9, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 859.25, "10th_percentile": 747.25, "90th_percentile": 859.25, "count": "1629" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "202" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 684.48, "10th_percentile": 684.48, "90th_percentile": 684.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 276.48, "count": "201" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "110" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 274.96, "10th_percentile": 239.12, "90th_percentile": 274.96, "count": "76" } ] } ] }, { "description": "MRI Breast Right Post Clip 77046", "code_information": [ { "code": "77046", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 988.25, "discounted_cash": 286.0, "minimum": 286.5925, "maximum": 988.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 988.25 } ] } ] }, { "description": "PROSTATECTOMY WITH MCC", "code_information": [ { "code": "665", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 36795.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36795.76 } ] } ] }, { "description": "Sodium, Stool", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.0, "discounted_cash": 20.0, "minimum": 20.3, "maximum": 63.49, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 39.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.05 } ] } ] }, { "description": "POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC", "code_information": [ { "code": "862", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 9733.344, "maximum": 21499.56, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11208.7, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 15599.36, "10th_percentile": 15599.36, "90th_percentile": 15599.36, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "OTElectrical Stim (Unattended) - Non-Wound - G0283 - 4520006", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "minimum": 18.705, "maximum": 64.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19278.0, "minimum": 19278.96, "maximum": 40726.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40726.21 } ] } ] }, { "description": "Urine Microscopic", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.25, "discounted_cash": 10.0, "minimum": 10.2225, "maximum": 31.9718, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 24.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.05, "10th_percentile": 3.05, "90th_percentile": 3.05, "count": "1 through 10" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 31579.7693, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 11432.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 21449.12, "10th_percentile": 21449.12, "90th_percentile": 21449.12, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21985.27 } ] } ] }, { "description": "Stool, Occult Blood, 3 Screening Samples - G0328 - 3203002", "code_information": [ { "code": "G0328", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.5, "minimum": 17.545, "maximum": 60.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 60.5 } ] } ] }, { "description": "XR Elbow Left AP+Lateral", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.75, "discounted_cash": 91.0, "minimum": 74.35, "maximum": 285.4783, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 92.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 629.5, "count": "1 through 10" } ] } ] }, { "description": "$ Fact13 Mix", "code_information": [ { "code": "85291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.5, "discounted_cash": 36.0, "minimum": 36.105, "maximum": 112.9215, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.91 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 71.93 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.45 } ] } ] }, { "description": "C. pneumoniae Antibody, IgM", "code_information": [ { "code": "86632", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 23.0, "minimum": 23.78, "maximum": 82.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.0 } ] } ] }, { "description": "EBV Nuclear Ab, IgG", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 52.0, "minimum": 52.345, "maximum": 163.7135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 121.9, "10th_percentile": 121.9, "90th_percentile": 121.9, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 180.5, "10th_percentile": 180.5, "90th_percentile": 180.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.76, "10th_percentile": 57.76, "90th_percentile": 57.76, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL VASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 8484.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8484.53 } ] } ] }, { "description": "CT Thoracic Spine wo Contrast", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1640.0, "discounted_cash": 475.0, "minimum": 475.6, "maximum": 1487.48, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 730.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1640.0, "10th_percentile": 1640.0, "90th_percentile": 1640.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 495.12, "10th_percentile": 495.12, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 524.8, "10th_percentile": 524.8, "90th_percentile": 524.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 495.12, "10th_percentile": 495.12, "90th_percentile": 524.8, "count": "1 through 10" } ] } ] }, { "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITH MCC", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15468.0, "minimum": 15468.01, "maximum": 50283.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50283.54 } ] } ] }, { "description": "TX FINGER SHAFT MANI FAC", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 361.75, "discounted_cash": 104.0, "minimum": 104.9075, "maximum": 328.1073, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 289.76, "10th_percentile": 289.76, "90th_percentile": 289.76, "count": "1 through 10" } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC", "code_information": [ { "code": "917", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 18489.84, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18489.84 } ] } ] }, { "description": "$ General Health Panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 576.5, "discounted_cash": 167.0, "minimum": 167.185, "maximum": 522.8855, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 463.15 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 19405.84, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19405.84 } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 21161.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21161.22 } ] } ] }, { "description": "MRI Breast Bilat w Contrast 77049", "code_information": [ { "code": "77049", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 939.0, "discounted_cash": 272.0, "minimum": 272.31, "maximum": 939.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 939.0 } ] } ] }, { "description": "Manual Differential", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.25, "discounted_cash": 10.0, "minimum": 10.5125, "maximum": 35.2279, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.23 } ] } ] }, { "description": "Ketorolac Tromethamine Inj 30 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016200", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 6.25, "10th_percentile": 6.25, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "822", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3362.0, "minimum": 3362.61, "maximum": 14193.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CCMCC", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 10843.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10843.5 } ] } ] }, { "description": "88311 AP Bill Decalcification", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 32.0, "minimum": 32.48, "maximum": 101.584, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.16, "10th_percentile": 76.16, "90th_percentile": 76.16, "count": "1 through 10" } ] } ] }, { "description": "Paroxysmal Nocturnal Hemoglobinuria (PNH) with FLAER (High Sensitivity)", "code_information": [ { "code": "88184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 62.0, "minimum": 62.7125, "maximum": 216.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.25 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12083.7, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12083.7 } ] } ] }, { "description": "IgG Subclass 1", "code_information": [ { "code": "82787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 19.0, "minimum": 19.14, "maximum": 66.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 249.0, "10th_percentile": 249.0, "90th_percentile": 249.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 79.68, "10th_percentile": 79.68, "90th_percentile": 79.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.13, "10th_percentile": 92.13, "90th_percentile": 92.13, "count": "1 through 10" } ] } ] }, { "description": "Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 27.0, "minimum": 27.405, "maximum": 85.7115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 67.66, "10th_percentile": 67.66, "90th_percentile": 67.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.02, "10th_percentile": 34.02, "90th_percentile": 34.02, "count": "17" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.77, "10th_percentile": 32.77, "90th_percentile": 32.77, "count": "23" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 75.69, "10th_percentile": 75.69, "90th_percentile": 77.49, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 74.28, "10th_percentile": 74.28, "90th_percentile": 75.7, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 94.5, "10th_percentile": 51.32, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 21.97, "10th_percentile": 21.64, "90th_percentile": 72.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "345" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.71, "10th_percentile": 30.24, "90th_percentile": 86.56, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "45" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 32.13, "count": "26" } ] } ] }, { "description": "SINUS AND MASTOID PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 11969.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11969.35 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 23707.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23707.64 } ] } ] }, { "description": "OT No Patient Present Train Initial 30 Min Unit", "code_information": [ { "code": "G0541", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.5, "minimum": 78.445, "maximum": 245.3435, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE WITHOUT CCMCC", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 8031.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8031.83 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16813.0, "minimum": 16813.05, "maximum": 38178.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38178.61 } ] } ] }, { "description": "88300 AP Bill Surgical Pathology Level I Complexity", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 36.0, "minimum": 36.25, "maximum": 125.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 81.59, "10th_percentile": 81.59, "90th_percentile": 81.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1.65, "10th_percentile": 1.65, "90th_percentile": 1.65, "count": "1 through 10" } ] } ] }, { "description": "Urinalysis with Sediment Exam", "code_information": [ { "code": "81001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 16.0, "minimum": 16.8925, "maximum": 52.8327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 41.71, "10th_percentile": 41.71, "90th_percentile": 41.71, "count": "14" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "count": "54" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.21, "10th_percentile": 20.21, "90th_percentile": 20.21, "count": "85" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 46.66, "10th_percentile": 37.11, "90th_percentile": 47.77, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.25, "10th_percentile": 3.17, "90th_percentile": 58.25, "count": "37" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 45.14, "10th_percentile": 13.54, "90th_percentile": 89.47, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "359" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 3.17, "90th_percentile": 19.81, "count": "232" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 46.56, "10th_percentile": 18.64, "90th_percentile": 53.36, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 21.55, "count": "122" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "52" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "76" } ] } ] }, { "description": "US Retroperitoneal Complete", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.75, "discounted_cash": 275.0, "minimum": 275.1375, "maximum": 860.5163, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 693.63, "10th_percentile": 693.63, "90th_percentile": 728.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 322.2, "10th_percentile": 322.2, "90th_percentile": 341.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 459.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 367.53 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 310.39, "10th_percentile": 310.39, "90th_percentile": 310.39, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 570.12, "10th_percentile": 570.12, "90th_percentile": 570.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 303.6, "90th_percentile": 304.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 948.75, "10th_percentile": 895.0, "90th_percentile": 948.75, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 331.15, "10th_percentile": 303.6, "90th_percentile": 860.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 303.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 303.6, "90th_percentile": 303.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 303.6, "10th_percentile": 286.4, "90th_percentile": 304.3, "count": "1 through 10" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 22035.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22035.96 } ] } ] }, { "description": "MRI Non-conditional approval 76016", "code_information": [ { "code": "76016", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.25, "discounted_cash": 76.0, "minimum": 76.6325, "maximum": 264.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 264.25 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC", "code_information": [ { "code": "640", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 15745.36, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10279.35, "10th_percentile": 10279.35, "90th_percentile": 20291.7, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15745.36 } ] } ] }, { "description": "NM Liver SPECT CT w Flow 78831", "code_information": [ { "code": "78831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5434.75, "discounted_cash": 1576.0, "minimum": 1576.0775, "maximum": 4929.3183, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4799.29 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7272.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7272.62 } ] } ] }, { "description": "Nitrogen Washout/Lung Volumes", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 593.0, "discounted_cash": 171.0, "minimum": 171.97, "maximum": 537.851, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.75, "10th_percentile": 79.11, "90th_percentile": 213.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 156.1, "10th_percentile": 143.43, "90th_percentile": 379.76, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.54, "10th_percentile": 76.21, "90th_percentile": 205.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 180.2, "10th_percentile": 180.2, "90th_percentile": 180.2, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 176.04, "10th_percentile": 176.04, "90th_percentile": 176.04, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.58, "10th_percentile": 55.21, "90th_percentile": 172.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 243.75, "10th_percentile": 219.75, "90th_percentile": 593.0, "count": "13" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 70.32, "90th_percentile": 189.76, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 221.08, "10th_percentile": 175.65, "90th_percentile": 221.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.6, "10th_percentile": 15.6, "90th_percentile": 299.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 78.0, "90th_percentile": 189.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 74.72, "90th_percentile": 189.76, "count": "1 through 10" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 2139.962, "maximum": 11319.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11319.78 } ] } ] }, { "description": "PNH w/ Flaer (High Sensitivity)", "code_information": [ { "code": "88185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.25, "discounted_cash": 62.0, "minimum": 62.7125, "maximum": 216.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 216.25 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 24364.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24364.28 } ] } ] }, { "description": "XR Fluoro Guide Needle Placmnt", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1437.75, "discounted_cash": 416.0, "minimum": 174.46, "maximum": 1304.0393, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 177.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 218.08 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 174.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 758.52 } ] } ] }, { "description": "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 28814.62, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28814.62 } ] } ] }, { "description": "TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 15007.833, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9417.04 } ] } ] }, { "description": "INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 92765.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 92765.13 } ] } ] }, { "description": "Metanephrines, Plasma", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 841.75, "discounted_cash": 244.0, "minimum": 137.1, "maximum": 763.4673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.58, "10th_percentile": 182.58, "90th_percentile": 182.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.86 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 137.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.04 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 255.0, "10th_percentile": 255.0, "90th_percentile": 841.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.6, "10th_percentile": 81.6, "90th_percentile": 311.45, "count": "1 through 10" } ] } ] }, { "description": "XR Mastoids 1-2 Views Ea Side", "code_information": [ { "code": "70120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.25, "discounted_cash": 140.0, "minimum": 94.37, "maximum": 440.1218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 96.27 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 } ] } ] }, { "description": "ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY", "code_information": [ { "code": "884", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 47927.034, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18967.29 } ] } ] }, { "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": 100.0, "minimum": 100.05, "maximum": 312.9822, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 264.96, "10th_percentile": 264.96, "90th_percentile": 264.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.2, "10th_percentile": 124.2, "90th_percentile": 124.2, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 212.46, "10th_percentile": 176.74, "90th_percentile": 220.94, "count": "18" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.65, "10th_percentile": 112.88, "90th_percentile": 119.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 207.34, "10th_percentile": 207.34, "90th_percentile": 219.77, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 271.17, "10th_percentile": 260.76, "90th_percentile": 271.17, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 220.59, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 102.25, "10th_percentile": 102.25, "90th_percentile": 252.26, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 345.0, "10th_percentile": 325.5, "90th_percentile": 345.0, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.4, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 298.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 120.44, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 110.4, "90th_percentile": 110.67, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.4, "10th_percentile": 104.16, "90th_percentile": 110.67, "count": "13" } ] } ] }, { "description": "NM Myocardial Spect Multi", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3984.25, "discounted_cash": 1155.0, "minimum": 1155.4325, "maximum": 3613.7148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1215.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1489.05 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1191.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3036.88 } ] } ] }, { "description": "MA Breast Tomo Lt Scrn 77063 52", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.5, "discounted_cash": 137.0, "minimum": 101.4819, "maximum": 430.3715, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 102.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.48 } ] } ] }, { "description": "C diff NAT", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 195.75, "discounted_cash": 56.0, "minimum": 56.7675, "maximum": 195.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 132.28, "10th_percentile": 132.28, "90th_percentile": 132.28, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.47, "10th_percentile": 66.51, "90th_percentile": 70.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.08, "10th_percentile": 64.08, "90th_percentile": 67.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 195.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.27, "10th_percentile": 37.27, "90th_percentile": 59.12, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 143.18, "10th_percentile": 143.18, "90th_percentile": 143.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 195.75, "10th_percentile": 184.75, "90th_percentile": 195.75, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.27, "10th_percentile": 37.27, "90th_percentile": 62.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 62.64, "90th_percentile": 62.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 37.27, "90th_percentile": 62.82, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.64, "10th_percentile": 62.64, "90th_percentile": 62.64, "count": "1 through 10" } ] } ] }, { "description": "Protein C Antigen", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.75, "discounted_cash": 20.0, "minimum": 20.2275, "maximum": 69.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 69.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.75 } ] } ] }, { "description": "Vent Assist Hospital Initial", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 835.5, "discounted_cash": 242.0, "minimum": 242.295, "maximum": 757.7985, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 598.22, "10th_percentile": 598.22, "90th_percentile": 598.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 835.5, "10th_percentile": 835.5, "90th_percentile": 835.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.36, "10th_percentile": 267.36, "90th_percentile": 267.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 267.36, "10th_percentile": 267.36, "90th_percentile": 267.36, "count": "1 through 10" } ] } ] }, { "description": "Von Willebrand Factor Activity", "code_information": [ { "code": "85245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.5, "discounted_cash": 90.0, "minimum": 90.915, "maximum": 284.3445, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.67 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC", "code_information": [ { "code": "854", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 23555.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23555.56 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR INJURIES WITH CC", "code_information": [ { "code": "908", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 23521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23521.37 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 11816.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11816.09 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 12789.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12789.86 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00990790209", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "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": 4483.0, "minimum": 4483.48, "maximum": 9316.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9316.83 } ] } ] }, { "description": "88104 AP Bill Non-Gyn Cytology", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.5, "discounted_cash": 26.0, "minimum": 26.535, "maximum": 91.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.5 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC", "code_information": [ { "code": "673", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22865.0, "minimum": 22865.75, "maximum": 49532.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49532.58 } ] } ] }, { "description": "NM Myocardial Infarct Avid Image", "code_information": [ { "code": "78466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 634.0, "discounted_cash": 183.0, "minimum": 183.86, "maximum": 634.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 559.16 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.0 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 4690.76, "maximum": 11449.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11449.46 } ] } ] }, { "description": "US Soft Tissue Head Neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 855.5, "discounted_cash": 248.0, "minimum": 248.095, "maximum": 775.9385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 577.81, "10th_percentile": 577.81, "90th_percentile": 577.81, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 307.98, "10th_percentile": 290.52, "90th_percentile": 307.98, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 296.69, "10th_percentile": 279.87, "90th_percentile": 296.69, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 514.06, "10th_percentile": 514.06, "90th_percentile": 514.06, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 672.42, "10th_percentile": 672.42, "90th_percentile": 672.42, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 710.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 11.23, "90th_percentile": 807.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 174.85, "10th_percentile": 174.85, "90th_percentile": 577.81, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 855.5, "10th_percentile": 807.0, "90th_percentile": 855.5, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 258.24, "90th_percentile": 274.38, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 645.04, "10th_percentile": 273.76, "90th_percentile": 775.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 266.31, "90th_percentile": 273.76, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 274.38, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.76, "10th_percentile": 273.76, "90th_percentile": 273.76, "count": "1 through 10" } ] } ] }, { "description": "Ova and Parasites, Conc and Perm Smear", "code_information": [ { "code": "87209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 39.0, "minimum": 39.15, "maximum": 135.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.14, "10th_percentile": 44.14, "90th_percentile": 44.14, "count": "1 through 10" }, { "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": 78.6, "median_amount": 101.94, "10th_percentile": 101.94, "90th_percentile": 101.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 135.0, "10th_percentile": 127.25, "90th_percentile": 135.0, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 122.45, "10th_percentile": 101.71, "90th_percentile": 122.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.72, "10th_percentile": 40.72, "90th_percentile": 43.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.98, "10th_percentile": 17.98, "90th_percentile": 17.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.2, "10th_percentile": 43.2, "90th_percentile": 43.2, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 12722.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12722.67 } ] } ] }, { "description": "XR Bone Survey Complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 630.25, "discounted_cash": 182.0, "minimum": 182.7725, "maximum": 623.1645, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 290.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 355.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 284.58 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 623.16 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 201.68, "10th_percentile": 201.68, "90th_percentile": 201.68, "count": "1 through 10" } ] } ] }, { "description": "Cystatin C, Serum", "code_information": [ { "code": "82610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.75, "discounted_cash": 77.0, "minimum": 77.6475, "maximum": 242.8493, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 93.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 91.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 171.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 267.75, "10th_percentile": 267.75, "90th_percentile": 267.75, "count": "1 through 10" } ] } ] }, { "description": "Iron Binding Capacity Total", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.25, "discounted_cash": 31.0, "minimum": 31.1025, "maximum": 97.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 76.79, "10th_percentile": 76.79, "90th_percentile": 76.79, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.61, "10th_percentile": 38.61, "90th_percentile": 38.61, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 70.77 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 68.32, "10th_percentile": 68.32, "90th_percentile": 68.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 85.92, "10th_percentile": 84.3, "90th_percentile": 85.92, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.25, "10th_percentile": 76.71, "90th_percentile": 107.25, "count": "23" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.93, "10th_percentile": 24.93, "90th_percentile": 82.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 31.1, "90th_percentile": 34.32, "count": "79" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 85.72, "10th_percentile": 34.32, "90th_percentile": 98.24, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 39.68, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 36.47, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 36.47, "count": "35" } ] } ] }, { "description": "MRI Cardiac w+wo 75561", "code_information": [ { "code": "75561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1654.5, "discounted_cash": 479.0, "minimum": 479.805, "maximum": 1654.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1654.5 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36092.0, "minimum": 36092.01, "maximum": 69905.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69905.11 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24651.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24651.94 } ] } ] }, { "description": "UNNABOOT FAC", "code_information": [ { "code": "29580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 707.75, "discounted_cash": 205.0, "minimum": 205.2475, "maximum": 641.9293, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 226.48, "10th_percentile": 226.48, "90th_percentile": 226.48, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 17012.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17012.68 } ] } ] }, { "description": "Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.5, "discounted_cash": 51.0, "minimum": 51.475, "maximum": 160.9925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 103.3 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 142.2, "10th_percentile": 142.2, "90th_percentile": 142.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 118.29 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 177.5, "10th_percentile": 177.5, "90th_percentile": 177.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 56.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 56.8, "10th_percentile": 56.8, "90th_percentile": 160.99, "count": "1 through 10" } ] } ] }, { "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": 39.0, "minimum": 39.295, "maximum": 135.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.5 } ] } ] }, { "description": "Transcut Bilirubin Test", "code_information": [ { "code": "88720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.25, "discounted_cash": 9.0, "minimum": 9.0625, "maximum": 31.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 37639.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37639.86 } ] } ] }, { "description": "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC", "code_information": [ { "code": "457", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 70298.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70298.87 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 29256.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29256.71 } ] } ] }, { "description": "Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.5, "discounted_cash": 14.0, "minimum": 14.645, "maximum": 49.18, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.18 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 39.35 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.51, "10th_percentile": 17.51, "90th_percentile": 17.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.5, "10th_percentile": 50.5, "90th_percentile": 50.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.16, "10th_percentile": 16.16, "90th_percentile": 16.16, "count": "1 through 10" } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CCMCC", "code_information": [ { "code": "735", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 15862.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15862.07 } ] } ] }, { "description": "US Breast Right Complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.75, "discounted_cash": 142.0, "minimum": 142.0275, "maximum": 489.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 359.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 287.43 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 489.75 } ] } ] }, { "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": 11881.0, "minimum": 11881.22, "maximum": 35608.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35608.61 } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC", "code_information": [ { "code": "757", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 10312.0, "maximum": 16880.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16880.64 } ] } ] }, { "description": "85097 AP Bill Bone Marrow Aspiration", "code_information": [ { "code": "85097", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 74.0, "minimum": 74.965, "maximum": 258.5, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.5 } ] } ] }, { "description": "NM MUGA Gated Cardiac SPECT", "code_information": [ { "code": "78494", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1029.25, "discounted_cash": 298.0, "minimum": 298.4825, "maximum": 1029.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 891.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1029.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 873.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1029.25 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57612.0, "minimum": 57612.72, "maximum": 141678.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 141678.78 } ] } ] }, { "description": "Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.5, "discounted_cash": 29.0, "minimum": 29.725, "maximum": 93.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 74.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.47 } ] } ] }, { "description": "Hepatitis B Surface Antigen - ECi", "code_information": [ { "code": "87340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 31.0, "minimum": 31.6825, "maximum": 104.46, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 88.17, "90th_percentile": 99.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.96, "10th_percentile": 34.96, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.73, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.92, "10th_percentile": 68.92, "90th_percentile": 68.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 39.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 83.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.38, "10th_percentile": 33.38, "90th_percentile": 33.38, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 69.59, "10th_percentile": 61.31, "90th_percentile": 78.93, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 77.11, "10th_percentile": 77.11, "90th_percentile": 85.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.76 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 74.59, "10th_percentile": 74.59, "90th_percentile": 83.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 109.25, "10th_percentile": 96.25, "90th_percentile": 109.25, "count": "71" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.8, "10th_percentile": 30.8, "90th_percentile": 34.96, "count": "1 through 10" } ] } ] }, { "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": 190.0, "minimum": 190.1675, "maximum": 594.7653, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.5, "10th_percentile": 45.5, "90th_percentile": 45.5, "count": "1 through 10" } ] } ] }, { "description": "Tobra", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.75, "discounted_cash": 62.0, "minimum": 62.8575, "maximum": 196.5923, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 133.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 130.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 149.53 } ] } ] }, { "description": "Oxalic Acid/Creat Ratio", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.25, "discounted_cash": 49.0, "minimum": 49.0825, "maximum": 153.5097, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.96 } ] } ] }, { "description": "Hepatitis B Core Antibody, IgM", "code_information": [ { "code": "86705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.25, "discounted_cash": 33.0, "minimum": 33.4225, "maximum": 115.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 77.87, "10th_percentile": 77.87, "90th_percentile": 77.87, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 97.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 95.2 }, { "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": 73.41, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 87.12, "10th_percentile": 87.12, "90th_percentile": 87.12, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 108.75, "10th_percentile": 108.75, "90th_percentile": 115.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.8, "10th_percentile": 34.8, "90th_percentile": 34.8, "count": "1 through 10" } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 2 Views", "code_information": [ { "code": "73521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 165.0, "minimum": 165.6625, "maximum": 518.1237, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 571.25, "10th_percentile": 571.25, "90th_percentile": 571.25, "count": "1 through 10" } ] } ] }, { "description": "88173 AP Bill FNA Interp and report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.25, "discounted_cash": 40.0, "minimum": 40.9625, "maximum": 141.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.25 } ] } ] }, { "description": "PULMONARY EMBOLISM WITHOUT MCC", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 19107.63, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5380.18, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9490.13 } ] } ] }, { "description": "$ Thyroglobulin by CIA", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.0, "discounted_cash": 67.0, "minimum": 67.57, "maximum": 211.331, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 83.88, "10th_percentile": 83.88, "90th_percentile": 83.88, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 132.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 129.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.88 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 233.0, "10th_percentile": 233.0, "90th_percentile": 233.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 74.56, "10th_percentile": 74.56, "90th_percentile": 74.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 211.33, "10th_percentile": 211.33, "90th_percentile": 211.33, "count": "1 through 10" } ] } ] }, { "description": "$ Complete Blood Count with Differential 85025", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.25, "discounted_cash": 27.0, "minimum": 27.3325, "maximum": 85.4848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 63.72, "10th_percentile": 63.72, "90th_percentile": 63.72, "count": "35" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.93, "10th_percentile": 32.04, "90th_percentile": 33.93, "count": "230" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.62 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.69, "10th_percentile": 30.87, "90th_percentile": 32.69, "count": "324" }, { "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": 60.04, "90th_percentile": 60.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.0, "10th_percentile": 8.4, "90th_percentile": 94.25, "count": "66" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 68.98, "10th_percentile": 20.38, "90th_percentile": 72.38, "count": "21" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.25, "10th_percentile": 89.0, "90th_percentile": 94.25, "count": "1565" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "750" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 81.52, "10th_percentile": 81.52, "90th_percentile": 81.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 32.93, "count": "500" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "314" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.16, "10th_percentile": 28.48, "90th_percentile": 30.26, "count": "296" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC", "code_information": [ { "code": "867", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 24676.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24676.69 } ] } ] }, { "description": "Sedimentation Rate", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.5, "discounted_cash": 23.0, "minimum": 23.925, "maximum": 74.8275, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 55.67, "10th_percentile": 55.67, "90th_percentile": 55.67, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.99, "10th_percentile": 27.99, "90th_percentile": 29.7, "count": "32" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.61, "10th_percentile": 26.97, "90th_percentile": 28.61, "count": "33" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 52.55, "10th_percentile": 52.55, "90th_percentile": 52.55, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 64.85, "10th_percentile": 62.29, "90th_percentile": 64.85, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.75, "10th_percentile": 19.07, "90th_percentile": 82.5, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 55.67, "10th_percentile": 19.18, "90th_percentile": 63.36, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 82.5, "10th_percentile": 77.75, "90th_percentile": 82.5, "count": "116" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 26.44, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 71.22, "10th_percentile": 26.4, "90th_percentile": 74.83, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 24.88, "90th_percentile": 28.77, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 4.27, "90th_percentile": 26.44, "count": "14" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.4, "10th_percentile": 26.4, "90th_percentile": 26.44, "count": "25" } ] } ] }, { "description": "Toxoplasmosis Ab, IgM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.5, "discounted_cash": 39.0, "minimum": 39.585, "maximum": 136.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 136.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.54 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 82.01, "10th_percentile": 82.01, "90th_percentile": 82.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.59 } ] } ] }, { "description": "OT Eval High Complex", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 145.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 19942.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19942.24 } ] } ] }, { "description": "XR Surgical Specimen Breast", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215.5, "discounted_cash": 62.0, "minimum": 45.76, "maximum": 215.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 46.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.5 } ] } ] }, { "description": "XR Enema Barium", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.25, "discounted_cash": 93.0, "minimum": 93.1625, "maximum": 321.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 321.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.25 } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES", "code_information": [ { "code": "769", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 19921.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19921.02 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC", "code_information": [ { "code": "740", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 21333.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21333.34 } ] } ] }, { "description": "OTA MMT, Total Body With Hand Units", "code_information": [ { "code": "95834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.75, "discounted_cash": 52.0, "minimum": 52.4175, "maximum": 163.9402, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "JAK2 V617F Mutation Analysis", "code_information": [ { "code": "81270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1464.5, "discounted_cash": 424.0, "minimum": 142.36, "maximum": 1328.3015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.23 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 177.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 142.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 849.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 372.56, "10th_percentile": 372.56, "90th_percentile": 372.56, "count": "1 through 10" } ] } ] }, { "description": "11-Deoxycortisol, Quant, Blood", "code_information": [ { "code": "82634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.75, "discounted_cash": 91.0, "minimum": 91.8575, "maximum": 296.06, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 241.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 296.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 236.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 271.44 } ] } ] }, { "description": "NM Shunt Ventricular Patency", "code_information": [ { "code": "78645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 662.75, "discounted_cash": 192.0, "minimum": 192.1975, "maximum": 662.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 662.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 662.75 } ] } ] }, { "description": "MAJOR THUMB OR JOINT PROCEDURES", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 15905.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15905.69 } ] } ] }, { "description": "OT Eval Low Complex", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 145.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.54, "10th_percentile": 180.54, "90th_percentile": 180.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 170.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 38347.19, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38347.19 } ] } ] }, { "description": "THA DISLOC WO ANES FAC", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.75, "discounted_cash": 108.0, "minimum": 108.0975, "maximum": 338.0842, "payers_information": [ { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 119.28, "10th_percentile": 119.28, "90th_percentile": 119.28, "count": "1 through 10" } ] } ] }, { "description": "CSF Cry Ag", "code_information": [ { "code": "87327", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.75, "discounted_cash": 187.0, "minimum": 92.71, "maximum": 586.6023, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 124.41 } ] } ] }, { "description": "HLA-B*57:01 for Abacavir Sensitivity", "code_information": [ { "code": "81381", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 667.25, "discounted_cash": 193.0, "minimum": 193.5025, "maximum": 667.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 667.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.25 } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 32503.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32503.4 } ] } ] }, { "description": "I-D PILONIDAL CYST FAC", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.25, "discounted_cash": 95.0, "minimum": 95.1925, "maximum": 297.7228, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 312.5, "10th_percentile": 312.5, "90th_percentile": 312.5, "count": "1 through 10" } ] } ] }, { "description": "Magnesium Sulfate IV Soln 4 GM/100ML (40 MG/ML)", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00338171540", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC", "code_information": [ { "code": "922", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 20623.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20623.64 } ] } ] }, { "description": "NM Hida Scan", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.0, "discounted_cash": 378.0, "minimum": 378.45, "maximum": 1305.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1186.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1163.36 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1305.0 } ] } ] }, { "description": "NM Arthrogram", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 521.75, "discounted_cash": 151.0, "minimum": 151.3075, "maximum": 521.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 521.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 521.75 } ] } ] }, { "description": "MEDICAL BACK PROBLEMS WITH MCC", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 19759.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19759.51 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 19445.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19445.92 } ] } ] }, { "description": "US Doppler Veloc Fetal Mid Cerebral Art", "code_information": [ { "code": "76821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.25, "discounted_cash": 119.0, "minimum": 119.8425, "maximum": 413.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 248.81 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 413.25 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITH CCMCC", "code_information": [ { "code": "713", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 17723.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17723.55 } ] } ] }, { "description": "Work Condition Initial 2 Hours OT", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 452.5, "discounted_cash": 131.0, "minimum": 95.0, "maximum": 410.4175, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SHORT LEG SPLINT FAC", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.25, "discounted_cash": 65.0, "minimum": 65.9025, "maximum": 206.1157, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 186.34, "10th_percentile": 186.34, "90th_percentile": 186.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 227.25, "10th_percentile": 216.5, "90th_percentile": 227.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 198.31, "10th_percentile": 72.72, "90th_percentile": 198.31, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "1 through 10" } ] } ] }, { "description": "Alcohol, Isopropyl", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.0, "discounted_cash": 270.0, "minimum": 103.9223, "maximum": 845.324, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.92 } ] } ] }, { "description": "MRI Shoulder Left wo Contrast", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2134.75, "discounted_cash": 619.0, "minimum": 619.0775, "maximum": 1936.2182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 768.51, "10th_percentile": 768.51, "90th_percentile": 768.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 740.34, "10th_percentile": 740.34, "90th_percentile": 740.34, "count": "1 through 10" }, { "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": 1226.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2134.75, "10th_percentile": 1924.75, "90th_percentile": 2134.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 1936.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "1 through 10" } ] } ] }, { "description": "ED US EXAM PELVIC LIMITED FAC", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 157.0, "minimum": 157.2525, "maximum": 491.8207, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 397.56, "10th_percentile": 397.56, "90th_percentile": 397.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 248.85 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in NaCl 0.45% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00990925739", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "G6PD Screen", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.5, "discounted_cash": 18.0, "minimum": 18.705, "maximum": 64.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 64.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.5 } ] } ] }, { "description": "Lidocaine HCl Local Inj 2%", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "55150025520", "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": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 13.54, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "Streptococcus Group A Screen", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 29.0, "minimum": 29.58, "maximum": 102.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.92, "10th_percentile": 68.92, "90th_percentile": 68.92, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.16, "10th_percentile": 10.53, "90th_percentile": 36.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.15, "10th_percentile": 10.15, "90th_percentile": 33.38, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 78.93, "10th_percentile": 78.92, "90th_percentile": 81.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 77.11, "10th_percentile": 77.11, "90th_percentile": 77.11, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.53, "10th_percentile": 9.95, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 68.92, "10th_percentile": 68.92, "90th_percentile": 68.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 96.25, "10th_percentile": 29.25, "90th_percentile": 102.0, "count": "302" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.53, "10th_percentile": 9.36, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 88.17, "10th_percentile": 81.53, "90th_percentile": 92.51, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 9.92, "90th_percentile": 32.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 30.8, "90th_percentile": 32.73, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.73, "10th_percentile": 32.73, "90th_percentile": 32.73, "count": "1 through 10" } ] } ] }, { "description": "Factor VIII Activity", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.5, "discounted_cash": 38.0, "minimum": 38.135, "maximum": 131.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 131.5, "10th_percentile": 131.5, "90th_percentile": 131.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.08, "10th_percentile": 42.08, "90th_percentile": 42.08, "count": "1 through 10" } ] } ] }, { "description": "Herpesvirus 6 DNA, QL RT PCR", "code_information": [ { "code": "87532", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.0, "discounted_cash": 92.0, "minimum": 92.8, "maximum": 320.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320.0 } ] } ] }, { "description": "KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18158.0, "minimum": 18158.09, "maximum": 38044.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38044.22 } ] } ] }, { "description": "Plasminogen Activator Inhib.1, Activity", "code_information": [ { "code": "85415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.0, "discounted_cash": 55.0, "minimum": 55.97, "maximum": 175.051, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 141.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 139.09 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.36 } ] } ] }, { "description": "NM Parathyrd Planar w SPECT", "code_information": [ { "code": "78071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1404.0, "discounted_cash": 407.0, "minimum": 407.16, "maximum": 1404.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1308.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1404.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1282.79 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.0 } ] } ] }, { "description": "OT Prosthetic Management, Initial 15", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 34.0, "minimum": 34.22, "maximum": 107.026, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Alpha Fetoprotein, Serum, Tumor Marker", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.25, "discounted_cash": 63.0, "minimum": 63.8725, "maximum": 199.7668, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.71 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.39, "10th_percentile": 76.39, "90th_percentile": 76.39, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.1, "10th_percentile": 25.4, "90th_percentile": 220.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 220.25, "10th_percentile": 220.25, "90th_percentile": 220.25, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 74.89, "10th_percentile": 74.89, "90th_percentile": 74.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 81.49, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.48, "10th_percentile": 70.48, "90th_percentile": 70.48, "count": "1 through 10" } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 3648.1707, "maximum": 8575.3, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8575.3 } ] } ] }, { "description": "Arsenic Level, Blood", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.75, "discounted_cash": 12.0, "minimum": 12.1075, "maximum": 41.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 41.75, "10th_percentile": 41.75, "90th_percentile": 41.75, "count": "1 through 10" } ] } ] }, { "description": "Reducing Substances, Fecal", "code_information": [ { "code": "84376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.135, "maximum": 31.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.5 } ] } ] }, { "description": "Urine, Drug Panel 6 with Confirmation", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.5, "discounted_cash": 74.0, "minimum": 74.965, "maximum": 258.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 364.62, "10th_percentile": 260.62, "90th_percentile": 364.62, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.87, "10th_percentile": 138.87, "90th_percentile": 183.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.38, "10th_percentile": 50.38, "90th_percentile": 176.61, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 131.4, "10th_percentile": 131.4, "90th_percentile": 293.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 177.24, "10th_percentile": 177.24, "90th_percentile": 203.18, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 258.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.88, "10th_percentile": 62.14, "90th_percentile": 509.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 364.0, "10th_percentile": 145.25, "90th_percentile": 539.75, "count": "126" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.28, "10th_percentile": 46.48, "90th_percentile": 224.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 466.47, "10th_percentile": 234.46, "90th_percentile": 489.55, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 75.92, "10th_percentile": 49.28, "90th_percentile": 162.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.39, "10th_percentile": 46.48, "90th_percentile": 172.72, "count": "25" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.28, "10th_percentile": 49.28, "90th_percentile": 143.48, "count": "1 through 10" } ] } ] }, { "description": "CT Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.5, "discounted_cash": 503.0, "minimum": 503.295, "maximum": 1691.07, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "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": 1220.99 } ] } ] }, { "description": "Immunofixation IFE, Urine", "code_information": [ { "code": "86335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.75, "discounted_cash": 63.0, "minimum": 63.1475, "maximum": 217.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.39, "10th_percentile": 78.39, "90th_percentile": 78.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 217.75, "10th_percentile": 217.75, "90th_percentile": 217.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.68, "10th_percentile": 69.68, "90th_percentile": 69.68, "count": "1 through 10" } ] } ] }, { "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": 2990.0, "minimum": 2990.915, "maximum": 9354.3445, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 6055.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 7420.33 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 5936.23 } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 11637.7619, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 4707.65, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4920.0, "10th_percentile": 4920.0, "90th_percentile": 4920.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7323.31 } ] } ] }, { "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": 4259.0, "minimum": 4259.31, "maximum": 15833.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15833.78 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4259.0, "minimum": 4259.31, "maximum": 9397.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9397.0 } ] } ] }, { "description": "Mycoplasma genitalium, rRNA, TMA", "code_information": [ { "code": "87563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 475.25, "discounted_cash": 137.0, "minimum": 137.8225, "maximum": 431.0518, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 38942.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38942.54 } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC", "code_information": [ { "code": "806", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8888.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8888.89 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 17409.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17409.97 } ] } ] }, { "description": "Bill IRL Ea Selected Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.25, "discounted_cash": 7.0, "minimum": 7.9025, "maximum": 27.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.25 } ] } ] }, { "description": "MRI Angio Neck w Contrast", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1744.5, "discounted_cash": 505.0, "minimum": 505.905, "maximum": 1744.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1548.04 } ] } ] }, { "description": "US Abdomen Complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1118.5, "discounted_cash": 324.0, "minimum": 324.365, "maximum": 1014.4795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 755.56, "10th_percentile": 755.56, "90th_percentile": 755.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 402.66, "10th_percentile": 402.66, "90th_percentile": 402.66, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 376.09 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 387.9, "10th_percentile": 387.9, "90th_percentile": 387.9, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 665.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1118.5, "10th_percentile": 1055.25, "90th_percentile": 1118.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 337.68, "10th_percentile": 337.68, "90th_percentile": 337.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 357.92, "10th_percentile": 357.92, "90th_percentile": 357.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 358.79, "10th_percentile": 358.79, "90th_percentile": 358.79, "count": "1 through 10" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 30315.978, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12152.08 } ] } ] }, { "description": "BK PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1171.0, "discounted_cash": 339.0, "minimum": 339.59, "maximum": 1062.097, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 421.56, "10th_percentile": 421.56, "90th_percentile": 421.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 } ] } ] }, { "description": "XR Abdomen 1 View 74018", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.75, "discounted_cash": 93.0, "minimum": 74.26, "maximum": 291.8272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.83, "10th_percentile": 115.83, "90th_percentile": 115.83, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.39 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 109.91 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.59, "10th_percentile": 111.59, "90th_percentile": 111.59, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 204.95, "10th_percentile": 204.95, "90th_percentile": 257.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 243.13, "10th_percentile": 243.13, "90th_percentile": 243.13, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 102.96, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 321.75, "10th_percentile": 303.5, "90th_percentile": 321.75, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 257.17, "10th_percentile": 102.96, "90th_percentile": 291.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.12, "10th_percentile": 58.88, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.12, "10th_percentile": 97.12, "90th_percentile": 102.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.96, "10th_percentile": 97.12, "90th_percentile": 103.19, "count": "1 through 10" } ] } ] }, { "description": "NM Brain Imaging Limited w Vascular Flow", "code_information": [ { "code": "78601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1401.75, "discounted_cash": 406.0, "minimum": 406.5075, "maximum": 1401.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 714.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 875.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 700.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1401.75 } ] } ] }, { "description": "INTRAOCULAR PROCEDURES WITH CCMCC", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 21315.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21315.65 } ] } ] }, { "description": "HDL Cholesterol", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.75, "discounted_cash": 41.0, "minimum": 41.1075, "maximum": 128.5673, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 66.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.93 } ] } ] }, { "description": "OSTEOMYELITIS WITHOUT CCMCC", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 9282.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9282.64 } ] } ] }, { "description": "Occult Blood, Stool", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 12.0, "minimum": 12.76, "maximum": 39.908, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.84, "10th_percentile": 15.84, "90th_percentile": 15.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.26, "10th_percentile": 15.26, "90th_percentile": 15.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4.23, "10th_percentile": 4.23, "90th_percentile": 44.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 44.0, "10th_percentile": 44.0, "90th_percentile": 44.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 4.23, "90th_percentile": 14.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.08, "10th_percentile": 14.08, "90th_percentile": 14.96, "count": "1 through 10" } ] } ] }, { "description": "Ethosuximide Level", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.75, "discounted_cash": 13.0, "minimum": 13.2675, "maximum": 45.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.75 } ] } ] }, { "description": "MRI Spectroscopy 76390", "code_information": [ { "code": "76390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1928.75, "discounted_cash": 559.0, "minimum": 559.3375, "maximum": 1928.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1928.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1553.05 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1928.75 } ] } ] }, { "description": "Glucose, 2 Hour Gestational", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 48.0, "minimum": 48.3575, "maximum": 151.2423, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.39, "10th_percentile": 119.39, "90th_percentile": 119.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 12.87, "10th_percentile": 12.87, "90th_percentile": 12.87, "count": "1 through 10" } ] } ] }, { "description": "KCl 20 MEQ/L (0.15%) in Dextrose 5% & NaCl 0.9% Inj", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264765200", "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": 76.8, "median_amount": 62.35, "10th_percentile": 62.35, "90th_percentile": 62.35, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "756", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 11323.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11323.32 } ] } ] }, { "description": "Throat, Group A Strep Screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.25, "discounted_cash": 36.0, "minimum": 36.0325, "maximum": 112.6947, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 83.95, "10th_percentile": 83.95, "90th_percentile": 83.95, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.21, "10th_percentile": 42.21, "90th_percentile": 44.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.67 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 46.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.67, "10th_percentile": 40.67, "90th_percentile": 40.67, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 74.69, "10th_percentile": 74.69, "90th_percentile": 96.15, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 93.93, "10th_percentile": 93.93, "90th_percentile": 93.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.87, "10th_percentile": 39.87, "90th_percentile": 39.87, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 83.95, "10th_percentile": 83.95, "90th_percentile": 83.95, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 117.25, "10th_percentile": 117.25, "90th_percentile": 124.25, "count": "163" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 107.4, "10th_percentile": 80.95, "90th_percentile": 112.69, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 39.76, "90th_percentile": 39.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.76, "10th_percentile": 37.52, "90th_percentile": 39.76, "count": "1 through 10" } ] } ] }, { "description": "Blood Urea Nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 16.0, "minimum": 16.8925, "maximum": 52.8327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.74, "10th_percentile": 44.74, "90th_percentile": 44.74, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.97, "10th_percentile": 20.97, "90th_percentile": 20.97, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.21, "10th_percentile": 20.21, "90th_percentile": 20.21, "count": "11" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.28, "10th_percentile": 12.88, "90th_percentile": 58.25, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 58.25, "10th_percentile": 58.25, "90th_percentile": 58.25, "count": "20" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 3.95, "90th_percentile": 19.81, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 52.83, "10th_percentile": 18.64, "90th_percentile": 52.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 21.55, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.64, "10th_percentile": 18.64, "90th_percentile": 19.81, "count": "1 through 10" } ] } ] }, { "description": "PCA3 (Prostate Cancer Biomarker)", "code_information": [ { "code": "81313", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1278.25, "discounted_cash": 370.0, "minimum": 370.6925, "maximum": 1278.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1278.25 } ] } ] }, { "description": "LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31384.0, "minimum": 31384.36, "maximum": 121550.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 121550.28 } ] } ] }, { "description": "SLP Non-Speech AAC Device Tx Units", "code_information": [ { "code": "92606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 148.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "99292 - Critical Care Ea Addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1064.0, "discounted_cash": 308.0, "minimum": 308.56, "maximum": 965.048, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 3706.09, "10th_percentile": 3706.09, "90th_percentile": 3706.09, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 8512.0, "10th_percentile": 8512.0, "90th_percentile": 8512.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1480.4, "10th_percentile": 1480.4, "90th_percentile": 2042.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 680.96, "10th_percentile": 680.96, "90th_percentile": 680.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2368.64, "10th_percentile": 2368.64, "90th_percentile": 2368.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 2368.64, "count": "1 through 10" } ] } ] }, { "description": "XR Cystogram 3 Views", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 653.5, "discounted_cash": 189.0, "minimum": 189.515, "maximum": 592.7245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.09 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 241.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 } ] } ] }, { "description": "Glucose, Fasting", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 19.0, "minimum": 19.285, "maximum": 60.3155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 39.74, "10th_percentile": 39.74, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.25, "10th_percentile": 19.25, "90th_percentile": 19.25, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 3.93, "10th_percentile": 3.93, "90th_percentile": 3.93, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.87, "10th_percentile": 18.87, "90th_percentile": 18.87, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.76, "10th_percentile": 17.76, "90th_percentile": 17.76, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 4", "code_information": [ { "code": "99214", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.25, "discounted_cash": 67.0, "minimum": 67.6425, "maximum": 211.5577, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.1, "10th_percentile": 44.1, "90th_percentile": 52.38, "count": "39" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.48, "10th_percentile": 42.48, "90th_percentile": 50.46, "count": "51" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.5, "10th_percentile": 48.36, "90th_percentile": 145.5, "count": "71" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 85.74, "10th_percentile": 84.07, "90th_percentile": 85.74, "count": "105" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.65, "10th_percentile": 39.2, "90th_percentile": 46.56, "count": "134" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 46.56, "10th_percentile": 39.2, "90th_percentile": 149.8, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.52, "10th_percentile": 9.31, "90th_percentile": 157.08, "count": "89" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.56, "10th_percentile": 39.2, "90th_percentile": 49.47, "count": "58" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.56, "10th_percentile": 39.2, "90th_percentile": 49.47, "count": "59" } ] } ] }, { "description": "US Transrectal", "code_information": [ { "code": "76872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624.0, "discounted_cash": 180.0, "minimum": 180.96, "maximum": 624.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 484.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 387.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 16555.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16555.26 } ] } ] }, { "description": "RPR", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 25.0, "minimum": 25.8825, "maximum": 80.9497, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 68.54, "10th_percentile": 65.29, "90th_percentile": 68.54, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.13, "10th_percentile": 32.13, "90th_percentile": 32.13, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 53.67, "10th_percentile": 53.67, "90th_percentile": 53.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 67.49, "10th_percentile": 67.49, "90th_percentile": 67.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.27, "10th_percentile": 4.27, "90th_percentile": 4.27, "count": "64" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.96, "10th_percentile": 26.96, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.95, "10th_percentile": 77.17, "90th_percentile": 80.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.56, "10th_percentile": 28.56, "90th_percentile": 28.56, "count": "1 through 10" } ] } ] }, { "description": "NEONATE WITH OTHER SIGNIFICANT PROBLEMS", "code_information": [ { "code": "794", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 17399.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17399.36 } ] } ] }, { "description": "FAC THORACENTESIS W/IM", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2153.0, "discounted_cash": 624.0, "minimum": 624.37, "maximum": 1952.771, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 746.66, "10th_percentile": 746.66, "90th_percentile": 746.66, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.33, "10th_percentile": 674.33, "90th_percentile": 674.33, "count": "1 through 10" } ] } ] }, { "description": "US Obstetrical Complete 14- Wk", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 774.0, "discounted_cash": 224.0, "minimum": 224.46, "maximum": 702.018, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 522.86, "10th_percentile": 522.86, "90th_percentile": 522.86, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 400.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 320.34 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 493.04, "10th_percentile": 493.04, "90th_percentile": 493.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600.63 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 594.43, "10th_percentile": 594.43, "90th_percentile": 594.43, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 774.0, "10th_percentile": 730.25, "90th_percentile": 774.0, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 668.91, "10th_percentile": 668.91, "90th_percentile": 668.91, "count": "1 through 10" } ] } ] }, { "description": "Tube #1 Nucleated Cells", "code_information": [ { "code": "89050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.5, "discounted_cash": 38.0, "minimum": 38.24, "maximum": 120.1775, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.01 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.8 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.24 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 80.0, "count": "1 through 10" } ] } ] }, { "description": "75743 FAC ARTERY X-RAYS LUNGS", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7671.25, "discounted_cash": 2224.0, "minimum": 609.0963, "maximum": 6957.8237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 875.32 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1072.56 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 858.05 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 609.1 } ] } ] }, { "description": "HC (SUP SHELL C1769) GUIDE WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 447.59, "10th_percentile": 447.59, "90th_percentile": 447.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.3, "10th_percentile": 20.3, "90th_percentile": 20.3, "count": "1 through 10" } ] } ] }, { "description": "Phosphorus, Random Urine", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 22.0, "minimum": 22.8375, "maximum": 71.4262, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.58 } ] } ] }, { "description": "Imipramine Level", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.0, "discounted_cash": 51.0, "minimum": 46.3525, "maximum": 160.539, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 } ] } ] }, { "description": "SPINAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 25879.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25879.17 } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 10955.025, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7076.92 } ] } ] }, { "description": "pH, Body Fluid", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.75, "discounted_cash": 18.0, "minimum": 18.1975, "maximum": 56.9143, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 28.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 21.77, "10th_percentile": 21.77, "90th_percentile": 21.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.19 } ] } ] }, { "description": "88165 AP Bill Gyn Diag Path", "code_information": [ { "code": "88165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.5, "discounted_cash": 28.0, "minimum": 28.855, "maximum": 99.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "description": "Ureaplasma/Mycoplasma hominis Culture", "code_information": [ { "code": "87109", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.25, "discounted_cash": 71.0, "minimum": 71.4125, "maximum": 223.3487, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 127.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 155.65 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 124.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.67 } ] } ] }, { "description": "SLP Eval Lang Comprehension,Express Unit", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 722.75, "discounted_cash": 209.0, "minimum": 95.0, "maximum": 655.5343, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Arthrogram Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 762.0, "discounted_cash": 220.0, "minimum": 220.98, "maximum": 691.134, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 277.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 339.66 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 271.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 631.63 } ] } ] }, { "description": "XR Tomography", "code_information": [ { "code": "76100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 642.25, "discounted_cash": 186.0, "minimum": 186.2525, "maximum": 582.5208, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 300.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 368.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 294.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 524.48 } ] } ] }, { "description": "OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 28356.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28356.03 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 25213.09, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25213.09 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19727.0, "minimum": 19727.31, "maximum": 57780.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57780.15 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH CC", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11791.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11791.34 } ] } ] }, { "description": "CT Pelvis wo Contrast", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1780.0, "discounted_cash": 516.0, "minimum": 516.2, "maximum": 1614.46, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 617.3, "10th_percentile": 617.3, "90th_percentile": 617.3, "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": 78.6, "median_amount": 1399.08, "10th_percentile": 1399.08, "90th_percentile": 1399.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721.85 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1780.0, "10th_percentile": 1780.0, "90th_percentile": 1780.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 537.36, "10th_percentile": 537.36, "90th_percentile": 570.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 537.36, "10th_percentile": 537.36, "90th_percentile": 537.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 621.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 569.6, "10th_percentile": 569.6, "90th_percentile": 570.95, "count": "1 through 10" } ] } ] }, { "description": "U Cystine 24HR", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.25, "discounted_cash": 55.0, "minimum": 55.7525, "maximum": 192.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.25 } ] } ] }, { "description": "OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC", "code_information": [ { "code": "802", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 46968.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46968.48 } ] } ] }, { "description": "Intrinsic Factor Blocking Antibody", "code_information": [ { "code": "86340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.75, "discounted_cash": 66.0, "minimum": 66.0475, "maximum": 206.5693, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.8 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 214.75, "10th_percentile": 214.75, "90th_percentile": 214.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.88, "10th_percentile": 72.88, "90th_percentile": 72.88, "count": "1 through 10" } ] } ] }, { "description": ".dRVVT Confirm", "code_information": [ { "code": "85597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.75, "discounted_cash": 48.0, "minimum": 37.79, "maximum": 165.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.24 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.49, "10th_percentile": 57.49, "90th_percentile": 57.49, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 156.25, "10th_percentile": 156.25, "90th_percentile": 156.25, "count": "1 through 10" } ] } ] }, { "description": "Thyroxine, Free (FT4)", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.0, "discounted_cash": 58.0, "minimum": 58.58, "maximum": 183.214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 144.63, "10th_percentile": 144.63, "90th_percentile": 144.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 72.72, "10th_percentile": 72.72, "90th_percentile": 72.72, "count": "34" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 72.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.05, "10th_percentile": 70.05, "90th_percentile": 70.05, "count": "21" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 128.67, "10th_percentile": 128.67, "90th_percentile": 165.64, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 158.77, "10th_percentile": 158.77, "90th_percentile": 161.82, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.3, "10th_percentile": 21.22, "90th_percentile": 202.0, "count": "16" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 155.14, "10th_percentile": 155.14, "90th_percentile": 155.14, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 202.0, "10th_percentile": 202.0, "90th_percentile": 202.0, "count": "131" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "78" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 183.21, "10th_percentile": 64.64, "90th_percentile": 185.03, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 64.64, "count": "43" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.64, "10th_percentile": 64.64, "90th_percentile": 68.68, "count": "34" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC", "code_information": [ { "code": "824", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 26709.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26709.11 } ] } ] }, { "description": "XR Pelvis 2 Views", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 579.75, "discounted_cash": 168.0, "minimum": 67.21, "maximum": 525.8333, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.8, "10th_percentile": 127.8, "90th_percentile": 127.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 68.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 67.21 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 246.23, "10th_percentile": 246.23, "90th_percentile": 246.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.74, "10th_percentile": 282.74, "90th_percentile": 282.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 355.0, "10th_percentile": 335.0, "90th_percentile": 579.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.2, "10th_percentile": 107.2, "90th_percentile": 113.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 306.86, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 113.6, "10th_percentile": 113.6, "90th_percentile": 113.6, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9753.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9753.02 } ] } ] }, { "description": "zzU24 OHProl", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 383.75, "discounted_cash": 111.0, "minimum": 111.2875, "maximum": 348.0612, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 245.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 196.67 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.27 } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 53786.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53786.04 } ] } ] }, { "description": ".MOG Antiobody Titer Serum", "code_information": [ { "code": "86362", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2012.0, "discounted_cash": 583.0, "minimum": 111.7095, "maximum": 1824.884, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.71 } ] } ] }, { "description": "Crystal Analysis-Synovial Fluid", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.25, "discounted_cash": 29.0, "minimum": 29.0725, "maximum": 90.9267, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 59.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 57.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.77, "10th_percentile": 34.77, "90th_percentile": 34.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 94.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 90.93, "10th_percentile": 90.93, "90th_percentile": 90.93, "count": "1 through 10" } ] } ] }, { "description": "XR Sinuses Limited 1-2 Views", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.25, "discounted_cash": 108.0, "minimum": 82.95, "maximum": 339.4447, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 84.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20848.0, "minimum": 20848.18, "maximum": 58221.06, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58221.06 } ] } ] }, { "description": "MRI Axilla Left w+wo 71552", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 870.0, "minimum": 870.2175, "maximum": 3000.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3000.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.76, "10th_percentile": 871.76, "90th_percentile": 871.76, "count": "1 through 10" } ] } ] }, { "description": "IR Venogram Epidural", "code_information": [ { "code": "75872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1408.25, "discounted_cash": 408.0, "minimum": 408.3925, "maximum": 1277.2828, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 939.51 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1151.22 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 920.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.43 } ] } ] }, { "description": "Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.75, "discounted_cash": 41.0, "minimum": 41.3975, "maximum": 134.31, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.12, "10th_percentile": 43.12, "90th_percentile": 43.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.12, "10th_percentile": 43.12, "90th_percentile": 49.86, "count": "1 through 10" } ] } ] }, { "description": "MRI Guided Needle Plcmt 77021", "code_information": [ { "code": "77021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000.0, "discounted_cash": 290.0, "minimum": 290.0, "maximum": 1000.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1000.0 } ] } ] }, { "description": "Fungal Culture, Blood", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 58.0, "minimum": 58.9425, "maximum": 189.6744, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 72.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.67 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 19698.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19698.21 } ] } ] }, { "description": "Erythrocyte Porphyrin (EP), Whole Blood", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.5, "discounted_cash": 101.0, "minimum": 101.935, "maximum": 318.8105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.03 } ] } ] }, { "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": 536.0, "minimum": 536.2825, "maximum": 1849.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 665.73, "10th_percentile": 665.73, "90th_percentile": 665.73, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1849.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 544.96, "10th_percentile": 544.96, "90th_percentile": 544.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1849.25, "10th_percentile": 1744.5, "90th_percentile": 1849.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 558.24, "10th_percentile": 558.24, "90th_percentile": 591.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 591.76, "10th_percentile": 591.76, "90th_percentile": 591.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 591.76, "10th_percentile": 591.76, "90th_percentile": 591.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 591.76, "10th_percentile": 591.76, "90th_percentile": 591.76, "count": "1 through 10" } ] } ] }, { "description": "MRI Sacrum wo 72195", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2153.5, "discounted_cash": 624.0, "minimum": 624.515, "maximum": 1953.2245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1210.04, "10th_percentile": 1210.04, "90th_percentile": 1210.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1412.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 540.8, "10th_percentile": 540.8, "90th_percentile": 540.8, "count": "1 through 10" } ] } ] }, { "description": "WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 21499.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21499.56 } ] } ] }, { "description": "Chemo Administraion SC/IM Non Hormonal", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 121.0, "minimum": 121.4375, "maximum": 379.8062, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 268.17, "10th_percentile": 260.26, "90th_percentile": 268.17, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.6, "10th_percentile": 127.6, "90th_percentile": 127.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 127.6, "90th_percentile": 147.54, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.0, "10th_percentile": 127.6, "90th_percentile": 134.0, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13165.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13165.93 } ] } ] }, { "description": "White Blood Cell", "code_information": [ { "code": "85048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 16.0, "minimum": 16.82, "maximum": 52.606, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.55 } ] } ] }, { "description": "REM FB SUBQ SIMPLE FAC", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.25, "discounted_cash": 87.0, "minimum": 87.0725, "maximum": 272.3268, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 221.65, "10th_percentile": 221.65, "90th_percentile": 221.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.09, "10th_percentile": 108.09, "90th_percentile": 108.09, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 236.0, "10th_percentile": 236.0, "90th_percentile": 236.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 286.0, "10th_percentile": 286.0, "90th_percentile": 300.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.33, "10th_percentile": 272.33, "90th_percentile": 272.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.52, "10th_percentile": 91.52, "90th_percentile": 91.52, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 91.52, "10th_percentile": 91.52, "90th_percentile": 91.52, "count": "1 through 10" } ] } ] }, { "description": "MRI Elbow Left w Contrast", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2214.75, "discounted_cash": 642.0, "minimum": 642.2775, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "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": 2080.99 } ] } ] }, { "description": "XR Enema Barium Double Contrast", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1280.5, "discounted_cash": 371.0, "minimum": 371.345, "maximum": 1280.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 566.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1280.5 } ] } ] }, { "description": "77011 FAC CT STEALTH LUMBAR", "code_information": [ { "code": "77011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 794.0, "discounted_cash": 230.0, "minimum": 230.26, "maximum": 794.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 794.0 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 794.0 } ] } ] }, { "description": "XR Scoliosis 2 or 3 Views", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 165.0, "minimum": 165.6625, "maximum": 518.1237, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.07 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 18413.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18413.21 } ] } ] }, { "description": "FAC REMOVE IMPCTD EAR WAX UNI", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.25, "discounted_cash": 81.0, "minimum": 81.2725, "maximum": 254.1867, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.68, "10th_percentile": 89.68, "90th_percentile": 89.68, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 96.12, "10th_percentile": 96.12, "90th_percentile": 96.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 267.0, "10th_percentile": 267.0, "90th_percentile": 267.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 85.44, "10th_percentile": 85.44, "90th_percentile": 85.44, "count": "1 through 10" } ] } ] }, { "description": "Enterovirus Detection by PCR", "code_information": [ { "code": "87498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.0, "discounted_cash": 105.0, "minimum": 105.56, "maximum": 330.148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.3 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 16479.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16479.82 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH MCC", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 22248.16, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22248.16 } ] } ] }, { "description": "XR Knees AP Standing", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.25, "discounted_cash": 90.0, "minimum": 81.52, "maximum": 283.2108, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 270.71 } ] } ] }, { "description": "MRI Lumbar Spine wo Contrast", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2134.75, "discounted_cash": 619.0, "minimum": 619.0775, "maximum": 1936.2182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1528.48, "10th_percentile": 1528.48, "90th_percentile": 1528.48, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 768.51, "10th_percentile": 768.51, "90th_percentile": 768.51, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 740.34, "10th_percentile": 740.34, "90th_percentile": 740.34, "count": "1 through 10" }, { "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": 1074.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 462.52, "10th_percentile": 462.52, "90th_percentile": 462.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2134.75, "10th_percentile": 2134.75, "90th_percentile": 2134.75, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 789.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 725.82, "count": "17" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 683.12, "10th_percentile": 683.12, "90th_percentile": 683.12, "count": "1 through 10" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 25121.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25121.14 } ] } ] }, { "description": "OTITIS MEDIA AND URI WITH MCC", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 13936.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13936.93 } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 15697.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15697.03 } ] } ] }, { "description": "Glucose, 3 Hour Gestational", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 16.0, "minimum": 16.095, "maximum": 50.3385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 39.74, "10th_percentile": 39.74, "90th_percentile": 39.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 23.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.09 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.34 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 55.5, "10th_percentile": 55.5, "90th_percentile": 55.5, "count": "1 through 10" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITHOUT CCMCC", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 18096.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18096.08 } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 17738.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17738.88 } ] } ] }, { "description": "IV Infusion Hydration 1 - 8 Hr", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "discounted_cash": 93.0, "minimum": 93.96, "maximum": 293.868, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 183.48, "10th_percentile": 183.48, "90th_percentile": 366.95, "count": "37" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 116.64, "10th_percentile": 116.64, "90th_percentile": 466.56, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.36, "10th_percentile": 112.36, "90th_percentile": 224.73, "count": "24" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 324.0, "10th_percentile": 324.0, "90th_percentile": 648.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 131.25, "10th_percentile": 131.25, "90th_percentile": 248.83, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 324.0, "10th_percentile": 324.0, "90th_percentile": 648.0, "count": "282" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 622.08, "count": "59" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 293.87, "10th_percentile": 103.68, "90th_percentile": 890.35, "count": "25" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.68, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "43" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.16, "10th_percentile": 103.68, "90th_percentile": 440.64, "count": "47" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.16, "10th_percentile": 103.68, "90th_percentile": 207.36, "count": "22" } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9414.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9414.68 } ] } ] }, { "description": "Bordetella pertussis IgG Ab", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.0, "discounted_cash": 134.0, "minimum": 106.68, "maximum": 420.848, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 108.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.34 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 106.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.28 } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 29376.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29376.96 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 7846.09, "maximum": 14989.69, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14989.69 } ] } ] }, { "description": "Factor VII, Activity", "code_information": [ { "code": "85230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 77.0, "minimum": 77.3575, "maximum": 241.9423, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 144.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.94 } ] } ] }, { "description": "MRI Abdomen wo Contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1549.25, "discounted_cash": 449.0, "minimum": 449.2825, "maximum": 1549.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1549.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1125.11 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1549.25, "10th_percentile": 1549.25, "90th_percentile": 1549.25, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 495.76, "10th_percentile": 495.76, "90th_percentile": 495.76, "count": "1 through 10" } ] } ] }, { "description": "IV Infusion Concurrent.", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.25, "discounted_cash": 93.0, "minimum": 93.4525, "maximum": 292.2808, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 230.73, "10th_percentile": 230.73, "90th_percentile": 230.73, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 116.01, "10th_percentile": 116.01, "90th_percentile": 116.01, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.76, "10th_percentile": 111.76, "90th_percentile": 111.76, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 322.25, "10th_percentile": 322.25, "90th_percentile": 322.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 322.25, "10th_percentile": 322.25, "90th_percentile": 322.25, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 103.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.12, "10th_percentile": 103.12, "90th_percentile": 109.57, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 109.57, "10th_percentile": 103.12, "90th_percentile": 109.57, "count": "1 through 10" } ] } ] }, { "description": "MHA-TP", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.75, "discounted_cash": 63.0, "minimum": 63.1475, "maximum": 197.4992, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 131.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 105.12 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.74 } ] } ] }, { "description": "XR Eye Foreign Body Detect", "code_information": [ { "code": "70030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 339.0, "discounted_cash": 98.0, "minimum": 75.77, "maximum": 307.473, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 339.0, "10th_percentile": 339.0, "90th_percentile": 339.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 307.47, "10th_percentile": 307.47, "90th_percentile": 307.47, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.48, "10th_percentile": 108.48, "90th_percentile": 108.48, "count": "1 through 10" } ] } ] }, { "description": "NM Renal Scan w Pharm Single", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1188.25, "discounted_cash": 344.0, "minimum": 344.5925, "maximum": 1077.7427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 528.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 647.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 517.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1015.09 } ] } ] }, { "description": "TX CMC DISLOC MANI FAC", "code_information": [ { "code": "26670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.5, "discounted_cash": 111.0, "minimum": 111.795, "maximum": 349.6485, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 117.52, "10th_percentile": 117.52, "90th_percentile": 117.52, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 3923.4709, "maximum": 12544.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12544.65 } ] } ] }, { "description": "Cryoglobulin, Qual Reflex Qual IgA, G+M", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.5, "discounted_cash": 7.0, "minimum": 7.105, "maximum": 24.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.5 } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12761.57, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12761.57 } ] } ] }, { "description": "Vitamin A (retinol)", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.25, "discounted_cash": 46.0, "minimum": 46.1825, "maximum": 144.4398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 114.02, "10th_percentile": 114.02, "90th_percentile": 114.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.82 }, { "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": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.58, "10th_percentile": 127.58, "90th_percentile": 127.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 159.25, "10th_percentile": 159.25, "90th_percentile": 159.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.96, "10th_percentile": 50.96, "90th_percentile": 54.15, "count": "1 through 10" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 28943.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28943.12 } ] } ] }, { "description": "CT Neck w Contrast", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2107.25, "discounted_cash": 611.0, "minimum": 611.1025, "maximum": 1911.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 715.68, "10th_percentile": 715.68, "90th_percentile": 715.68, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1304.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1043.93 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 730.8, "10th_percentile": 730.8, "90th_percentile": 730.8, "count": "1 through 10" }, { "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": 1051.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 589.32, "10th_percentile": 551.16, "90th_percentile": 1314.64, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2107.25, "10th_percentile": 1988.0, "90th_percentile": 2107.25, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 636.16, "90th_percentile": 674.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 674.32, "90th_percentile": 675.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 674.32, "10th_percentile": 674.32, "90th_percentile": 674.32, "count": "1 through 10" } ] } ] }, { "description": "HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 20483.35, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20483.35 } ] } ] }, { "description": "SLP Evaluation of Speech Fluency Units", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.25, "discounted_cash": 124.0, "minimum": 95.0, "maximum": 388.4228, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITHOUT MCC", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 10824.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10824.64 } ] } ] }, { "description": "US Obstetrical Multi 14+ Wk", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 881.5, "discounted_cash": 255.0, "minimum": 210.23, "maximum": 799.5205, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 262.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.23 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 349.66 } ] } ] }, { "description": "XR Skull Complete 4 Views", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 620.0, "discounted_cash": 179.0, "minimum": 121.57, "maximum": 562.34, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 151.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 265.04 } ] } ] }, { "description": "XR Nephrostogram-Loopogram", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1163.25, "discounted_cash": 337.0, "minimum": 201.63, "maximum": 1055.0677, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 205.68 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 252.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 201.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 950.28 } ] } ] }, { "description": "88368 AP Bill Manual Morph Analysis, Insitu Hybrid - 88368 - 3302012 - 3302012", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1494.5, "discounted_cash": 433.0, "minimum": 433.405, "maximum": 1355.5115, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1232.51 } ] } ] }, { "description": "Chromosome Analysis Prod. of Conception", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 772.25, "discounted_cash": 223.0, "minimum": 223.9525, "maximum": 772.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 772.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 772.25 } ] } ] }, { "description": "ROOM/BED: Observation", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 113.03, "minimum": 32.7787, "maximum": 102.5182, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1790.4, "10th_percentile": 1261.41, "90th_percentile": 2848.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1332.76, "10th_percentile": 235.19, "90th_percentile": 2590.6, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1070.24, "10th_percentile": 1070.24, "90th_percentile": 1070.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1130.25, "10th_percentile": 308.25, "90th_percentile": 2260.5, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 759.56, "10th_percentile": 289.36, "90th_percentile": 2367.36, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 375.0, "10th_percentile": 375.0, "90th_percentile": 375.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 319.35, "10th_percentile": 230.16, "90th_percentile": 1644.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 361.7, "10th_percentile": 217.02, "90th_percentile": 868.07, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 2061.67, "10th_percentile": 2061.67, "90th_percentile": 2061.67, "count": "1 through 10" } ] } ] }, { "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": 7846.0, "minimum": 7846.09, "maximum": 42515.78, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42515.78 } ] } ] }, { "description": "Transfuse Blood", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1284.5, "discounted_cash": 372.0, "minimum": 372.505, "maximum": 1165.0415, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 462.42, "10th_percentile": 396.0, "90th_percentile": 462.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 822.59, "10th_percentile": 822.59, "90th_percentile": 822.59, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 445.46, "10th_percentile": 424.23, "90th_percentile": 445.46, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 1003.07, "10th_percentile": 1003.07, "90th_percentile": 1003.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1284.5, "10th_percentile": 1223.25, "90th_percentile": 1284.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 391.44, "10th_percentile": 391.44, "90th_percentile": 415.91, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 411.04, "90th_percentile": 411.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 411.04, "90th_percentile": 411.04, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.04, "10th_percentile": 391.44, "90th_percentile": 415.91, "count": "1 through 10" } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 33119.96, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33119.96 } ] } ] }, { "description": "Plethysmography Lung Volumes", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1180.25, "discounted_cash": 342.0, "minimum": 342.2725, "maximum": 1070.4868, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 167.43, "10th_percentile": 167.43, "90th_percentile": 167.43, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 219.5, "10th_percentile": 219.5, "90th_percentile": 219.5, "count": "1 through 10" } ] } ] }, { "description": "AFB Culture with AFB Smear", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 53.0, "minimum": 53.07, "maximum": 165.981, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.21 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.31 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 87.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 100.12 } ] } ] }, { "description": "75746 FAC PULMONARY NONSELECTIVE", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2069.75, "discounted_cash": 600.0, "minimum": 600.2275, "maximum": 1877.2632, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 894.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1095.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 876.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 702.11 } ] } ] }, { "description": "Vitamin B1 (Thiamine), Whole Blood", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.5, "discounted_cash": 81.0, "minimum": 81.635, "maximum": 255.3205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 0.35, "10th_percentile": 0.35, "90th_percentile": 201.2, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 101.34, "10th_percentile": 101.34, "90th_percentile": 101.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 175.3 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 214.81 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 171.85 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.62, "10th_percentile": 97.62, "90th_percentile": 97.62, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 179.32, "10th_percentile": 179.32, "90th_percentile": 179.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 225.51, "10th_percentile": 225.51, "90th_percentile": 225.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.81 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 281.5, "10th_percentile": 281.5, "90th_percentile": 281.5, "count": "22" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 257.85, "10th_percentile": 257.85, "90th_percentile": 257.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 90.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 90.08, "10th_percentile": 90.08, "90th_percentile": 95.71, "count": "1 through 10" } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11208.0, "minimum": 11208.7, "maximum": 20016.51, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20016.51 } ] } ] }, { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 14028.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14028.89 } ] } ] }, { "description": "MRI Angio Abdomen w+wo Contrast", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2499.75, "discounted_cash": 724.0, "minimum": 724.9275, "maximum": 2267.2733, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "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": 2224.82 } ] } ] }, { "description": "Rapid Identification for Anaerobes WrkSht", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.5, "discounted_cash": 12.0, "minimum": 12.325, "maximum": 42.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 42.28 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 40.0, "10th_percentile": 40.0, "90th_percentile": 42.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.8, "10th_percentile": 40.8, "90th_percentile": 40.8, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.6, "10th_percentile": 13.6, "90th_percentile": 13.6, "count": "1 through 10" } ] } ] }, { "description": "96360 - ED IV Infusion Hydration 31 min/1 HR", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 57.0, "minimum": 57.42, "maximum": 179.586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 141.77, "10th_percentile": 141.77, "90th_percentile": 141.77, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.28, "10th_percentile": 71.28, "90th_percentile": 71.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.67, "10th_percentile": 68.67, "90th_percentile": 175.23, "count": "13" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.0, "10th_percentile": 131.52, "90th_percentile": 198.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 198.0, "10th_percentile": 198.0, "90th_percentile": 198.0, "count": "84" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 181.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 63.36, "count": "23" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.36, "10th_percentile": 63.36, "90th_percentile": 67.32, "count": "1 through 10" } ] } ] }, { "description": "Poliovirus Ab Type 1 - 86382 - 3350487 - 3350487", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.75, "discounted_cash": 78.0, "minimum": 78.8075, "maximum": 246.4772, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 171.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.76 } ] } ] }, { "description": "TB INTRADERMAL", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.25, "discounted_cash": 10.0, "minimum": 10.8025, "maximum": 37.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 36.0, "10th_percentile": 36.0, "90th_percentile": 38.25, "count": "1 through 10" } ] } ] }, { "description": "Calculi (Stone) Analysis", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.5, "discounted_cash": 72.0, "minimum": 72.355, "maximum": 226.2965, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.45 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.44 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 180.0, "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": 4259.0, "minimum": 4259.31, "maximum": 18819.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18819.93 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 55311.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55311.54 } ] } ] }, { "description": "Leuprolide Acetate (6 Month) For Subcutaneous Inj Kit 45 MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "62935046150", "type": "NDC" }, { "code": "J9217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2847.34, "10th_percentile": 2847.34, "90th_percentile": 2847.34, "count": "1 through 10" } ] } ] }, { "description": "RHIG - J2790 - 3001009", "code_information": [ { "code": "J2790", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.25, "minimum": 118.9725, "maximum": 410.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 410.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.94 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 310.35 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 243.05 } ] } ] }, { "description": "LUNG TRANSPLANT", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44162.0, "minimum": 44162.28, "maximum": 152669.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 152669.65 } ] } ] }, { "description": "XR Hip Bilateral w Pelvis 3 or 4 Views", "code_information": [ { "code": "73522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 165.0, "minimum": 165.6625, "maximum": 518.1237, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 338.39 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 571.25, "10th_percentile": 571.25, "90th_percentile": 571.25, "count": "1 through 10" } ] } ] }, { "description": "Coccidioides Ab by CF", "code_information": [ { "code": "86635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.25, "discounted_cash": 18.0, "minimum": 18.9225, "maximum": 65.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.25 } ] } ] }, { "description": "XR Ribs Left w PA Chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 619.0, "discounted_cash": 179.0, "minimum": 101.55, "maximum": 561.433, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 210.24, "10th_percentile": 210.24, "90th_percentile": 222.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 103.59 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 101.55 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 202.53, "10th_percentile": 202.53, "90th_percentile": 214.67, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.56, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 619.0, "10th_percentile": 584.0, "90th_percentile": 619.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 186.88, "90th_percentile": 216.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 186.88, "10th_percentile": 186.88, "90th_percentile": 186.88, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.08, "10th_percentile": 198.08, "90th_percentile": 198.08, "count": "1 through 10" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 23496.3302, "payers_information": [ { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "other", "standard_charge_dollar": 20520.13, "standard_charge_algorithm": "78.6% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 18774.32, "10th_percentile": 18774.32, "90th_percentile": 18774.32, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6431.46, "10th_percentile": 6431.46, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10565.28 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 7764.6091, "maximum": 19218.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19218.4 } ] } ] }, { "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": 3586.0, "minimum": 3586.78, "maximum": 14173.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14173.89 } ] } ] }, { "description": "OT Massage Units", "code_information": [ { "code": "97124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.0, "discounted_cash": 46.0, "minimum": 46.98, "maximum": 146.934, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 16354.85, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16354.85 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 20367.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20367.82 } ] } ] }, { "description": "MRI Femur Left wo Contrast", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1990.75, "discounted_cash": 577.0, "minimum": 577.3175, "maximum": 1805.6102, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "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": 1409.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 676.86, "10th_percentile": 676.86, "90th_percentile": 676.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1990.75, "10th_percentile": 1990.75, "90th_percentile": 1990.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1591.21, "10th_percentile": 1591.21, "90th_percentile": 1591.21, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 637.04, "10th_percentile": 637.04, "90th_percentile": 637.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 676.86, "10th_percentile": 676.86, "90th_percentile": 676.86, "count": "1 through 10" } ] } ] }, { "description": "IR Dilitation Biliary Duct S+I", "code_information": [ { "code": "74363", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1748.0, "discounted_cash": 506.0, "minimum": 334.61, "maximum": 1585.436, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 341.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 418.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 334.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 640.1 } ] } ] }, { "description": "URINARY STONES WITH MCC", "code_information": [ { "code": "693", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 15850.28, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15850.28 } ] } ] }, { "description": "Brucella Antibody", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.0, "discounted_cash": 28.0, "minimum": 28.42, "maximum": 88.886, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 70.32 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.79 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 23351.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23351.61 } ] } ] }, { "description": "CT Simulation Simple", "code_information": [ { "code": "77280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1031.25, "discounted_cash": 299.0, "minimum": 299.0625, "maximum": 935.3438, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 590.6 } ] } ] }, { "description": "75710 FAC LE ANGIO IMAGING UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8207.75, "discounted_cash": 2380.0, "minimum": 583.6917, "maximum": 7444.4293, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 929.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1138.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 910.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.69 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "819", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3586.0, "minimum": 3586.78, "maximum": 10137.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10137.34 } ] } ] }, { "description": "Kleihauer-Betke (RhIG))", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.25, "discounted_cash": 91.0, "minimum": 62.62, "maximum": 285.9318, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.88 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.66 } ] } ] }, { "description": "PT Canalith Repositioning Units", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.75, "discounted_cash": 39.0, "minimum": 39.6575, "maximum": 124.0323, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "CT Angiography Pelvis w+wo Contrast", "code_information": [ { "code": "72191", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1825.75, "discounted_cash": 529.0, "minimum": 529.4675, "maximum": 1825.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1744.7 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1825.75 } ] } ] }, { "description": "$ AP 88323 Consult", "code_information": [ { "code": "88323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1179.5, "discounted_cash": 342.0, "minimum": 340.6909, "maximum": 1069.8065, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 340.69 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 30562.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30562.93 } ] } ] }, { "description": "MRI Lumbar Spine w+wo Contrast", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2606.0, "discounted_cash": 755.0, "minimum": 755.74, "maximum": 2606.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 938.16, "10th_percentile": 938.16, "90th_percentile": 938.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2606.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "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": 1869.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2606.0, "10th_percentile": 2606.0, "90th_percentile": 2606.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 833.92, "10th_percentile": 833.92, "90th_percentile": 833.92, "count": "1 through 10" } ] } ] }, { "description": "XR Thoracic Spine w Swimmers", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.75, "discounted_cash": 134.0, "minimum": 107.26, "maximum": 421.5283, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 245.3 } ] } ] }, { "description": "Cmv antibody", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.0, "discounted_cash": 52.0, "minimum": 52.49, "maximum": 164.167, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.4 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 19350.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19350.43 } ] } ] }, { "description": "Hepatitis B Surface Ag Confirmation", "code_information": [ { "code": "87341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 40.0, "minimum": 40.6725, "maximum": 127.2067, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 83.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.76 } ] } ] }, { "description": "Tricyclic Antidepressants, Urine Qual.", "code_information": [ { "code": "80305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.5, "discounted_cash": 40.0, "minimum": 40.455, "maximum": 126.5265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.95 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 66.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.81 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CCMCC", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 15856.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15856.18 } ] } ] }, { "description": "Bill IRL Agsc Pt Serum", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.5, "discounted_cash": 87.0, "minimum": 76.92, "maximum": 274.3675, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 76.92 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 151.48 } ] } ] }, { "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": 42.0, "minimum": 42.2675, "maximum": 145.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.75 } ] } ] }, { "description": "Prothrombin 20210 G/A Mutation by PCR", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.25, "discounted_cash": 42.0, "minimum": 42.7025, "maximum": 147.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 51.07, "10th_percentile": 51.07, "90th_percentile": 51.07, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 46.99, "10th_percentile": 46.99, "90th_percentile": 46.99, "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": 10760.0, "minimum": 10760.35, "maximum": 18197.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18197.47 } ] } ] }, { "description": "Rbc antibody identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 364.25, "discounted_cash": 105.0, "minimum": 105.6325, "maximum": 364.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 436.0, "10th_percentile": 436.0, "90th_percentile": 474.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.76, "10th_percentile": 151.76, "90th_percentile": 151.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.76, "10th_percentile": 151.76, "90th_percentile": 151.76, "count": "1 through 10" } ] } ] }, { "description": "MRI Axilla Left wo 71550", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2314.75, "discounted_cash": 671.0, "minimum": 671.2775, "maximum": 2314.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1725.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1380.01 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2314.75 } ] } ] }, { "description": "MRI Forearm Left w+wo Contrast", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2724.25, "discounted_cash": 790.0, "minimum": 790.0325, "maximum": 2715.4265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2715.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 871.76, "10th_percentile": 871.76, "90th_percentile": 871.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1007.97, "10th_percentile": 1007.97, "90th_percentile": 1007.97, "count": "1 through 10" } ] } ] }, { "description": "TPMT Genetics, Prometheus", "code_information": [ { "code": "81401", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1489.5, "discounted_cash": 431.0, "minimum": 254.08, "maximum": 1350.9765, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 254.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1270.06 } ] } ] }, { "description": "XR Orbits 4 Views", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.25, "discounted_cash": 170.0, "minimum": 117.25, "maximum": 532.6358, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.56 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 117.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 293.25 } ] } ] }, { "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": 16364.0, "minimum": 16364.7, "maximum": 33604.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33604.49 } ] } ] }, { "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": 24.0, "minimum": 24.215, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "US Intra-Operative", "code_information": [ { "code": "76998", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.75, "discounted_cash": 175.0, "minimum": 175.0875, "maximum": 547.6013, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 307.45 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 245.96 } ] } ] }, { "description": "NM GE Reflux Scan", "code_information": [ { "code": "78262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.5, "discounted_cash": 256.0, "minimum": 256.215, "maximum": 883.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 809.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 883.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 793.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 883.5 } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 11303.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11303.27 } ] } ] }, { "description": "XR Calcaneous Right Min 2 Views", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 107.0, "minimum": 71.49, "maximum": 337.404, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 72.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.36 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 71.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 177.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 372.0, "10th_percentile": 372.0, "90th_percentile": 372.0, "count": "1 through 10" } ] } ] }, { "description": "Blood Parasite, Tick-Borne", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.5, "discounted_cash": 21.0, "minimum": 21.895, "maximum": 68.4785, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 51.02, "10th_percentile": 51.02, "90th_percentile": 51.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 48.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 26.18, "10th_percentile": 26.18, "90th_percentile": 26.18, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 45.39, "10th_percentile": 45.39, "90th_percentile": 45.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 59.34, "10th_percentile": 59.34, "90th_percentile": 59.34, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.53 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 75.5, "10th_percentile": 71.25, "90th_percentile": 75.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.16, "10th_percentile": 22.8, "90th_percentile": 24.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.16, "10th_percentile": 24.16, "90th_percentile": 24.16, "count": "1 through 10" } ] } ] }, { "description": "XR Cholangiogram w Fluoro in the OR", "code_information": [ { "code": "74300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1014.0, "discounted_cash": 294.0, "minimum": 135.84, "maximum": 919.698, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 203.03 } ] } ] }, { "description": "XR Fistula Sinus Tract Abcess", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 796.5, "discounted_cash": 230.0, "minimum": 141.59, "maximum": 722.4255, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 144.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 141.59 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 298.91 } ] } ] }, { "description": "Eosinophils Smear, Other", "code_information": [ { "code": "89190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 97.5, "discounted_cash": 28.0, "minimum": 28.275, "maximum": 88.4325, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.68 } ] } ] }, { "description": "SLP Speech AAC Eval Addl Half Hour Units", "code_information": [ { "code": "92608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 384.75, "discounted_cash": 111.0, "minimum": 95.0, "maximum": 348.9683, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Kappa/Lambda Light Chains, Free with Ratio, Random Urine", "code_information": [ { "code": "83521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.5, "discounted_cash": 27.0, "minimum": 27.405, "maximum": 94.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.77, "10th_percentile": 32.77, "90th_percentile": 32.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 30.24, "10th_percentile": 30.24, "90th_percentile": 30.24, "count": "1 through 10" } ] } ] }, { "description": "$ Comprehensive Metabolic Panel 80053", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 78.0, "minimum": 78.155, "maximum": 244.4365, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 182.04, "10th_percentile": 182.04, "90th_percentile": 182.04, "count": "52" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 97.02, "10th_percentile": 91.53, "90th_percentile": 97.02, "count": "272" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.28 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.56 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 93.46, "10th_percentile": 88.18, "90th_percentile": 93.46, "count": "361" }, { "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": 171.67, "90th_percentile": 171.67, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 211.83, "10th_percentile": 203.68, "90th_percentile": 211.83, "count": "126" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 97.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.08, "10th_percentile": 18.33, "90th_percentile": 269.5, "count": "118" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 62.64, "10th_percentile": 58.23, "90th_percentile": 206.98, "count": "23" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 269.5, "10th_percentile": 254.25, "90th_percentile": 269.5, "count": "1637" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.24, "count": "899" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 232.89, "10th_percentile": 232.89, "90th_percentile": 232.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 94.07, "count": "602" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.45, "count": "290" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 86.24, "10th_percentile": 81.36, "90th_percentile": 86.45, "count": "383" } ] } ] }, { "description": "IR Venogram Vena Cava Superior", "code_information": [ { "code": "75827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2245.75, "discounted_cash": 651.0, "minimum": 558.2871, "maximum": 2036.8953, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 834.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1022.51 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 818.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 558.29 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7431.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7431.77 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 12990.573, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 8575.28, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10008.84 } ] } ] }, { "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": 375.0, "minimum": 375.1875, "maximum": 1173.4313, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 752.34, "10th_percentile": 752.34, "90th_percentile": 752.34, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 400.95, "10th_percentile": 378.27, "90th_percentile": 400.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 685.83, "10th_percentile": 685.82, "90th_percentile": 713.25, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 364.41, "10th_percentile": 364.41, "90th_percentile": 386.25, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 892.11, "10th_percentile": 892.11, "90th_percentile": 892.11, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 841.76, "10th_percentile": 841.76, "90th_percentile": 875.41, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 356.4, "10th_percentile": 356.4, "90th_percentile": 357.26, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 752.34, "10th_percentile": 752.34, "90th_percentile": 752.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1050.75, "10th_percentile": 1050.75, "90th_percentile": 1113.75, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 356.4, "10th_percentile": 336.24, "90th_percentile": 357.26, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 356.4, "10th_percentile": 336.24, "90th_percentile": 1010.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 356.4, "10th_percentile": 336.24, "90th_percentile": 356.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 356.4, "10th_percentile": 356.4, "90th_percentile": 357.26, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 356.4, "10th_percentile": 356.4, "90th_percentile": 357.26, "count": "1 through 10" } ] } ] }, { "description": "Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.5, "discounted_cash": 30.0, "minimum": 30.885, "maximum": 96.5955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.34, "10th_percentile": 36.18, "90th_percentile": 38.34, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.85 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 53.48 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.32, "10th_percentile": 12.32, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 100.5, "10th_percentile": 100.5, "90th_percentile": 106.5, "count": "18" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.08, "10th_percentile": 34.08, "90th_percentile": 37.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.16, "10th_percentile": 32.16, "90th_percentile": 34.08, "count": "1 through 10" } ] } ] }, { "description": "Folate Level", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 42.0, "minimum": 42.485, "maximum": 146.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.89, "10th_percentile": 104.89, "90th_percentile": 104.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.74, "10th_percentile": 52.74, "90th_percentile": 52.74, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.37 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 118.98 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.81, "10th_percentile": 50.81, "90th_percentile": 50.81, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 93.32, "10th_percentile": 93.32, "90th_percentile": 93.32, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 115.15, "10th_percentile": 115.15, "90th_percentile": 117.36, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 136.28 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 34.05, "10th_percentile": 34.05, "90th_percentile": 34.05, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 146.5, "10th_percentile": 146.5, "90th_percentile": 146.5, "count": "62" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 132.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 46.88, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.81, "10th_percentile": 46.88, "90th_percentile": 49.81, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.88, "10th_percentile": 46.88, "90th_percentile": 49.81, "count": "11" } ] } ] }, { "description": "Myoglobin, Urine", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 42.0, "minimum": 42.485, "maximum": 132.8755, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.62 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.51 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.77 } ] } ] }, { "description": "MRI Cervical Spine w Contrast", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2230.0, "discounted_cash": 646.0, "minimum": 646.7, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1686.2 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 5511.2094, "maximum": 19232.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19232.54 } ] } ] }, { "description": "SIM REP FACE <2.5 FAC", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 115.0, "minimum": 115.42, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 257.3, "10th_percentile": 257.3, "90th_percentile": 257.3, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 272.24, "10th_percentile": 272.24, "90th_percentile": 272.24, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 265.97, "10th_percentile": 265.97, "90th_percentile": 265.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.0, "10th_percentile": 332.0, "90th_percentile": 398.0, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 106.24, "90th_percentile": 128.86, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 304.11, "10th_percentile": 304.11, "90th_percentile": 318.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 111.52, "10th_percentile": 106.24, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.86, "10th_percentile": 128.86, "90th_percentile": 128.86, "count": "1 through 10" } ] } ] }, { "description": ".ADAMTS13 Inhibitor", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.0, "discounted_cash": 139.0, "minimum": 104.18, "maximum": 436.267, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.28 } ] } ] }, { "description": "Insulin Antibody", "code_information": [ { "code": "86337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.5, "discounted_cash": 92.0, "minimum": 92.945, "maximum": 290.6935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 173.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 302.25, "10th_percentile": 302.25, "90th_percentile": 302.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.56, "10th_percentile": 102.56, "90th_percentile": 102.56, "count": "1 through 10" } ] } ] }, { "description": "BD DXA Bone Density Axial Skeleton w VFA", "code_information": [ { "code": "77085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.5, "discounted_cash": 130.0, "minimum": 130.935, "maximum": 409.5105, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 167.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 205.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 164.47 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 332.72 } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 26060.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26060.72 } ] } ] }, { "description": "XR VCUG in Radiology", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.25, "discounted_cash": 225.0, "minimum": 225.1125, "maximum": 750.051, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 294.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 361.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 288.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 750.05 } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 21295.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21295.61 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18606.0, "minimum": 18606.44, "maximum": 84060.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84060.14 } ] } ] }, { "description": "WOUND DEBRIDEMENTS FOR INJURIES WITH MCC", "code_information": [ { "code": "901", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18830.0, "minimum": 18830.62, "maximum": 49473.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49473.63 } ] } ] }, { "description": "TUBE THORACOSTOMY FAC", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1511.75, "discounted_cash": 438.0, "minimum": 438.4075, "maximum": 1371.1572, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1511.75, "10th_percentile": 1511.75, "90th_percentile": 1511.75, "count": "1 through 10" } ] } ] }, { "description": "Vitamin E (alpha-Tocophenol)", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.75, "discounted_cash": 40.0, "minimum": 40.2375, "maximum": 138.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 106.56, "10th_percentile": 106.56, "90th_percentile": 106.56, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.02 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 138.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 114.71 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 88.38, "10th_percentile": 88.38, "90th_percentile": 88.38, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.15, "10th_percentile": 111.15, "90th_percentile": 111.15, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.46 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 138.75, "10th_percentile": 138.75, "90th_percentile": 138.75, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 44.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.4, "10th_percentile": 44.4, "90th_percentile": 47.18, "count": "1 through 10" } ] } ] }, { "description": "Creatinine Clearance Ur", "code_information": [ { "code": "82575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.5, "discounted_cash": 54.0, "minimum": 54.375, "maximum": 170.0625, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 77.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 76.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.7 } ] } ] }, { "description": "C1-Esterase Inhibitor", "code_information": [ { "code": "86161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.0, "discounted_cash": 59.0, "minimum": 59.16, "maximum": 185.028, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 90.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.25 } ] } ] }, { "description": "CT Entire Upper Extrem LT WO Contrast", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1503.5, "discounted_cash": 436.0, "minimum": 436.015, "maximum": 1363.6745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 866.36, "10th_percentile": 866.36, "90th_percentile": 866.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 461.7, "10th_percentile": 461.7, "90th_percentile": 461.7, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 963.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 770.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 444.77, "10th_percentile": 444.77, "90th_percentile": 444.77, "count": "1 through 10" }, { "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": 1003.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1210.0, "10th_percentile": 1210.0, "90th_percentile": 1282.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 387.2, "10th_percentile": 387.2, "90th_percentile": 411.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1025.1, "10th_percentile": 1025.1, "90th_percentile": 1025.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 410.4, "10th_percentile": 410.4, "90th_percentile": 410.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 411.4, "10th_percentile": 411.4, "90th_percentile": 411.4, "count": "1 through 10" } ] } ] }, { "description": "H influenza B Ab, IgG", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.5, "discounted_cash": 71.0, "minimum": 71.195, "maximum": 222.6685, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.84 } ] } ] }, { "description": "OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "832", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 8506.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8506.93 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 9857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9857.95 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 10760.35, "maximum": 28233.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28233.43 } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 11660.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11660.48 } ] } ] }, { "description": "74160 FAC CT ABDOMEN W CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2757.25, "discounted_cash": 799.0, "minimum": 650.0, "maximum": 2500.8257, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1478.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1182.67 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 855.65, "10th_percentile": 855.65, "90th_percentile": 855.65, "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": 78.6, "median_amount": 1939.26, "10th_percentile": 1939.26, "90th_percentile": 1939.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1519.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 704.52, "10th_percentile": 704.52, "90th_percentile": 704.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2467.25, "10th_percentile": 2467.25, "90th_percentile": 2467.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 789.52, "10th_percentile": 744.8, "90th_percentile": 789.52, "count": "1 through 10" } ] } ] }, { "description": "CT Guided Needle Biopsy-Aspiration", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1778.75, "discounted_cash": 515.0, "minimum": 515.8375, "maximum": 1613.3263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 570.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 698.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 559.16 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 597.76 } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 9518.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9518.42 } ] } ] }, { "description": "CT Lung Screen 71271", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.0, "discounted_cash": 111.0, "minimum": 111.65, "maximum": 385.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 260.09, "10th_percentile": 260.09, "90th_percentile": 260.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.6, "10th_percentile": 130.77, "90th_percentile": 138.6, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 363.25, "10th_percentile": 363.25, "90th_percentile": 385.0, "count": "30" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.52, "10th_percentile": 125.98, "90th_percentile": 133.52, "count": "11" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 302.61, "10th_percentile": 291.0, "90th_percentile": 302.61, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 385.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.51, "count": "40" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 123.49, "10th_percentile": 123.49, "90th_percentile": 281.52, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 385.0, "10th_percentile": 363.25, "90th_percentile": 385.0, "count": "61" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 134.4, "10th_percentile": 116.24, "90th_percentile": 349.2, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.2, "10th_percentile": 116.24, "90th_percentile": 123.2, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.2, "10th_percentile": 123.2, "90th_percentile": 123.2, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.51, "10th_percentile": 123.2, "90th_percentile": 123.51, "count": "25" } ] } ] }, { "description": "IR Adrenal Vein Scan Unilateral S+I", "code_information": [ { "code": "75840", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1307.25, "discounted_cash": 379.0, "minimum": 379.1025, "maximum": 1185.6758, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 837.38 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1026.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 820.86 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 634.43 } ] } ] }, { "description": "SKIN ULCERS WITH CC", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 13985.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13985.27 } ] } ] }, { "description": "Paraffin Bath OT", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.25, "discounted_cash": 20.0, "minimum": 20.6625, "maximum": 71.25, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.25 } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12480.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12480.99 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 56925.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56925.45 } ] } ] }, { "description": "XR Sinuses Complete 3-4 Views", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.25, "discounted_cash": 165.0, "minimum": 104.4, "maximum": 518.1237, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 231.24 } ] } ] }, { "description": "Echo 2D Comprehensive w/Contrast - 93306 - 5001009", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2535.0, "discounted_cash": 735.0, "minimum": 735.15, "maximum": 2299.245, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 706.66, "10th_percentile": 706.66, "90th_percentile": 1108.4, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 912.6, "10th_percentile": 912.6, "90th_percentile": 912.6, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 1623.41, "10th_percentile": 1623.41, "90th_percentile": 1654.59, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 879.14, "10th_percentile": 879.14, "90th_percentile": 879.14, "count": "15" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 2030.54, "10th_percentile": 2030.54, "90th_percentile": 2078.7, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1992.51, "10th_percentile": 1992.51, "90th_percentile": 1992.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 884.13, "10th_percentile": 409.64, "90th_percentile": 934.83, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2535.0, "10th_percentile": 2535.0, "90th_percentile": 2535.0, "count": "30" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 187.59, "10th_percentile": 162.24, "90th_percentile": 2299.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 233.68, "10th_percentile": 162.24, "90th_percentile": 1012.57, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 811.2, "10th_percentile": 811.2, "90th_percentile": 861.9, "count": "18" } ] } ] }, { "description": "Theo", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.25, "discounted_cash": 44.0, "minimum": 44.7325, "maximum": 143.11, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 116.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.11 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 114.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.08 } ] } ] }, { "description": "Von Willebrand Factor Multimer Assay", "code_information": [ { "code": "85247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.0, "discounted_cash": 112.0, "minimum": 112.23, "maximum": 351.009, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 212.67 } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "670", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 11521.37, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11521.37 } ] } ] }, { "description": "$ Hepatic Function Panel 80076", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.25, "discounted_cash": 66.0, "minimum": 66.11, "maximum": 207.9298, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 154.84, "10th_percentile": 154.84, "90th_percentile": 154.84, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.85, "10th_percentile": 8.17, "90th_percentile": 82.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 67.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 66.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.51, "10th_percentile": 75.0, "90th_percentile": 79.51, "count": "1 through 10" }, { "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": 146.03, "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": 78.6, "median_amount": 180.19, "10th_percentile": 180.19, "90th_percentile": 180.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.76, "10th_percentile": 73.53, "90th_percentile": 114.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 229.25, "10th_percentile": 216.25, "90th_percentile": 229.25, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 8.17, "90th_percentile": 73.53, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 207.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 73.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 73.36, "90th_percentile": 73.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.36, "10th_percentile": 69.2, "90th_percentile": 73.53, "count": "13" } ] } ] }, { "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": 5156.0, "minimum": 5156.0, "maximum": 17312.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17312.12 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 30406.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30406.14 } ] } ] }, { "description": "NM Cisternogram", "code_information": [ { "code": "78630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1027.0, "discounted_cash": 297.0, "minimum": 297.83, "maximum": 1027.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1027.0 } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 13214.27, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13214.27 } ] } ] }, { "description": "Troponin", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.5, "discounted_cash": 57.0, "minimum": 57.565, "maximum": 180.0395, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 142.13, "10th_percentile": 142.13, "90th_percentile": 142.13, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.46, "10th_percentile": 71.46, "90th_percentile": 142.92, "count": "27" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.54 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 79.63 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.84, "10th_percentile": 68.84, "90th_percentile": 137.68, "count": "47" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 162.77, "10th_percentile": 159.0, "90th_percentile": 318.0, "count": "12" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 159.02, "10th_percentile": 156.02, "90th_percentile": 312.04, "count": "19" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 198.5, "10th_percentile": 170.81, "90th_percentile": 595.5, "count": "15" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 198.5, "10th_percentile": 198.5, "90th_percentile": 397.0, "count": "258" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "81" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 180.04, "10th_percentile": 63.52, "90th_percentile": 360.08, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "106" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 127.04, "count": "88" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 63.52, "10th_percentile": 63.52, "90th_percentile": 134.98, "count": "47" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11881.0, "minimum": 11881.22, "maximum": 41123.5, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41123.5 } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17485.0, "minimum": 17485.57, "maximum": 42034.79, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42034.79 } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 15298.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15298.56 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 13336.87, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13336.87 } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12875.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12875.92 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8248.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8248.75 } ] } ] }, { "description": "75630 FAC AORTOGRAPHY LEG ART S&I", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8204.75, "discounted_cash": 2379.0, "minimum": 547.0189, "maximum": 7441.7082, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 901.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1104.73 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 883.78 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 547.02 } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15582.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15582.67 } ] } ] }, { "description": "Parvovirus B19 Ab IgG", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 405.75, "discounted_cash": 117.0, "minimum": 75.31, "maximum": 368.0152, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.92, "10th_percentile": 237.92, "90th_percentile": 237.92, "count": "1 through 10" } ] } ] }, { "description": ".Thrombin Clotting Time", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.5, "discounted_cash": 20.0, "minimum": 20.735, "maximum": 64.8505, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 46.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.49 } ] } ] }, { "description": "B-Cell Receptor IGK Gene Rearrangement, PCR", "code_information": [ { "code": "81264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 203.0, "minimum": 203.0, "maximum": 700.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27797.0, "minimum": 27797.58, "maximum": 84558.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84558.82 } ] } ] }, { "description": "US Elastography Parenchyma 76981", "code_information": [ { "code": "76981", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.0, "discounted_cash": 157.0, "minimum": 157.18, "maximum": 542.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.0 } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 62202.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 62202.2 } ] } ] }, { "description": "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CCMCC", "code_information": [ { "code": "494", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 23654.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23654.59 } ] } ] }, { "description": "PT Physical Performance Test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.25, "discounted_cash": 48.0, "minimum": 48.2125, "maximum": 150.7887, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [ { "code": "876", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16364.0, "minimum": 16364.7, "maximum": 45563.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45563.23 } ] } ] }, { "description": "CT Liver RF Ablation 47382", "code_information": [ { "code": "47382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18977.5, "discounted_cash": 5503.0, "minimum": 650.0, "maximum": 17212.5925, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "XR Video Swallowing Study", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 889.0, "discounted_cash": 257.0, "minimum": 243.1, "maximum": 843.133, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 247.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 303.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 243.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 843.13 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16364.0, "minimum": 16364.7, "maximum": 41999.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41999.42 } ] } ] }, { "description": "ED US LMTD JT NONVASC XTR STRUX FAC", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 429.25, "discounted_cash": 124.0, "minimum": 42.9, "maximum": 389.3297, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.63 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 42.9 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.87, "10th_percentile": 148.87, "90th_percentile": 148.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.24 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 429.25, "10th_percentile": 429.25, "90th_percentile": 429.25, "count": "1 through 10" } ] } ] }, { "description": "REVISION OF HIP OR KNEE REPLACEMENT WITH CC", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 41575.02, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41575.02 } ] } ] }, { "description": "ST Fat Qnt", "code_information": [ { "code": "82710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.5, "discounted_cash": 56.0, "minimum": 56.115, "maximum": 175.5045, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.92, "10th_percentile": 61.92, "90th_percentile": 61.92, "count": "1 through 10" } ] } ] }, { "description": "CTA Head + Neck w+wo Contrast 70471", "code_information": [ { "code": "70471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1351.0, "discounted_cash": 391.0, "minimum": 391.79, "maximum": 1225.357, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "XR Arthrogram Knee", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 526.25, "discounted_cash": 152.0, "minimum": 152.6125, "maximum": 526.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 369.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 452.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 361.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.25 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 3126.0165, "maximum": 6673.74, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6673.74 } ] } ] }, { "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": 32.0, "minimum": 32.8425, "maximum": 113.25, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.25 } ] } ] }, { "description": "CT Ankle Left w+wo Contrast", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1635.25, "discounted_cash": 474.0, "minimum": 474.2225, "maximum": 1635.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1635.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.32 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 523.28, "10th_percentile": 523.28, "90th_percentile": 523.28, "count": "1 through 10" } ] } ] }, { "description": "Total Bili, (Fibrotest)", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.5, "discounted_cash": 38.0, "minimum": 38.715, "maximum": 121.0845, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 41.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.77 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 40.62 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.48, "10th_percentile": 14.48, "90th_percentile": 14.48, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.04, "10th_percentile": 85.04, "90th_percentile": 85.04, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 106.95, "10th_percentile": 106.95, "90th_percentile": 106.95, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.86, "10th_percentile": 131.86, "90th_percentile": 131.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 50.0, "10th_percentile": 41.75, "90th_percentile": 133.5, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 13.36, "10th_percentile": 13.36, "90th_percentile": 42.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.72, "10th_percentile": 42.72, "90th_percentile": 42.72, "count": "1 through 10" } ] } ] }, { "description": "CT Elbow Left w Contrast", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1606.5, "discounted_cash": 465.0, "minimum": 465.885, "maximum": 1457.0955, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1312.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1049.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.13, "10th_percentile": 557.13, "90th_percentile": 557.13, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1283.0 } ] } ] }, { "description": "CT Lumbar Spine w+wo Contrast", "code_information": [ { "code": "72133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2028.75, "discounted_cash": 588.0, "minimum": 588.3375, "maximum": 1840.0763, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1691.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1215.32 } ] } ] }, { "description": "BD DXA Vertebral Fracture", "code_information": [ { "code": "77086", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 61.0, "minimum": 61.335, "maximum": 211.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 134.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.5 } ] } ] }, { "description": "Omalizumab Subcutaneous Soln Auto-Injector 150 MG/ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "50242021555", "type": "NDC" }, { "code": "J2357", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 18206.35, "10th_percentile": 17413.05, "90th_percentile": 18206.35, "count": "1 through 10" } ] } ] }, { "description": "US Bone Density Measurement", "code_information": [ { "code": "76977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 70.0, "minimum": 39.4728, "maximum": 219.9475, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.2 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.47 } ] } ] }, { "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": 13674.0, "minimum": 13674.61, "maximum": 37969.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37969.95 } ] } ] }, { "description": "US Hysterosonography", "code_information": [ { "code": "76831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 877.25, "discounted_cash": 254.0, "minimum": 254.4025, "maximum": 795.6658, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 339.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 416.49 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 333.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 696.51 } ] } ] }, { "description": "MRI Abdomen w Contrast", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 626.0, "minimum": 626.11, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1948.44 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 43687.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43687.6 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 11007.561, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7799.68, "10th_percentile": 7799.68, "90th_percentile": 13649.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4287.64, "10th_percentile": 4287.64, "90th_percentile": 6431.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12300.0, "10th_percentile": 12300.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 5828.52, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9689.89, "10th_percentile": 9689.89, "90th_percentile": 9689.89, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9174.18 } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 9051.58, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9051.58 } ] } ] }, { "description": "Vaginal Screen, Trichomonas", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 18.0, "minimum": 18.995, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.15, "10th_percentile": 60.15, "90th_percentile": 60.15, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "Gastrin Level", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.25, "discounted_cash": 44.0, "minimum": 44.1525, "maximum": 152.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.57 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 142.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.25 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.72, "10th_percentile": 48.72, "90th_percentile": 48.72, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 14376.66, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14376.66 } ] } ] }, { "description": "XR Arthrogram Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 872.5, "discounted_cash": 253.0, "minimum": 253.025, "maximum": 872.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 297.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 364.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 291.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 872.5 } ] } ] }, { "description": "Caffeine lvl", "code_information": [ { "code": "80155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 387.75, "discounted_cash": 112.0, "minimum": 106.95, "maximum": 357.5632, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 109.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 133.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 106.95 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 357.56 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 17921.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17921.61 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 5830.7352, "maximum": 11965.81, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7173.57, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11965.81 } ] } ] }, { "description": "Triiodothyronine (T3), Reverse", "code_information": [ { "code": "84482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.25, "discounted_cash": 49.0, "minimum": 49.9525, "maximum": 156.2308, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 125.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 153.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 123.19 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.1 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 20239.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20239.32 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 18116.13, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18116.13 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3138.0, "minimum": 3138.44, "maximum": 16496.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16496.32 } ] } ] }, { "description": "Worm ID", "code_information": [ { "code": "87169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 76.5, "discounted_cash": 22.0, "minimum": 22.185, "maximum": 69.3855, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 76.5, "10th_percentile": 76.5, "90th_percentile": 76.5, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 26944.89, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26944.89 } ] } ] }, { "description": "99195 PHLEBOTOMY THERAP S", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 403.5, "discounted_cash": 117.0, "minimum": 117.015, "maximum": 365.9745, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 145.26, "10th_percentile": 145.26, "90th_percentile": 145.26, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 258.4, "10th_percentile": 258.4, "90th_percentile": 258.4, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.33, "10th_percentile": 80.33, "90th_percentile": 129.12, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 384.25, "10th_percentile": 384.25, "90th_percentile": 384.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.96, "10th_percentile": 122.96, "90th_percentile": 142.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 129.12, "10th_percentile": 122.96, "90th_percentile": 130.65, "count": "1 through 10" } ] } ] }, { "description": "IR Lymphangiogram Pelvic-Abd Bilat", "code_information": [ { "code": "75807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1581.75, "discounted_cash": 458.0, "minimum": 458.7075, "maximum": 1581.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 974.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1194.1 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 955.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1581.75 } ] } ] }, { "description": "CT Head w+wo Contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2254.5, "discounted_cash": 653.0, "minimum": 650.0, "maximum": 2044.8315, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2254.5, "10th_percentile": 2254.5, "90th_percentile": 2254.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 721.44, "10th_percentile": 721.44, "90th_percentile": 721.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 680.64, "10th_percentile": 680.64, "90th_percentile": 723.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1098.29 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1001.02 } ] } ] }, { "description": "Succinylcholine Chloride Inj 20 MG/ML", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "31722098110", "type": "NDC" }, { "code": "J0330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 95.48, "10th_percentile": 95.48, "90th_percentile": 95.48, "count": "1 through 10" } ] } ] }, { "description": "MRI Elbow Left w+wo Contrast", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 870.0, "minimum": 870.2175, "maximum": 2721.6802, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2670.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2515.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2721.68, "10th_percentile": 2721.68, "90th_percentile": 2721.68, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 14628.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14628.95 } ] } ] }, { "description": "Ther Ivntj 1st 15 Min OT", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.75, "discounted_cash": 27.0, "minimum": 27.7675, "maximum": 95.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "Hemochromatosis Mutation-PCR", "code_information": [ { "code": "81256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 335.75, "discounted_cash": 97.0, "minimum": 97.3675, "maximum": 335.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 335.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 107.44, "10th_percentile": 107.44, "90th_percentile": 107.44, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4311.1944, "maximum": 7325.67, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 5153.76, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 7087.5, "10th_percentile": 7087.5, "90th_percentile": 7087.5, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7325.67 } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10465.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10465.08 } ] } ] }, { "description": "XR Hand Left AP+Lateral", "code_information": [ { "code": "73120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.75, "discounted_cash": 70.0, "minimum": 70.6875, "maximum": 221.0813, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 74.39 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 72.92 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 195.24, "10th_percentile": 195.24, "90th_percentile": 195.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 200.23 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 230.0, "10th_percentile": 230.0, "90th_percentile": 243.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.0, "10th_percentile": 78.0, "90th_percentile": 78.0, "count": "1 through 10" } ] } ] }, { "description": "INT REP FACE 5.1-7.5 FAC", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 558.75, "discounted_cash": 162.0, "minimum": 162.0375, "maximum": 506.7862, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 797.92, "10th_percentile": 797.92, "90th_percentile": 797.92, "count": "1 through 10" } ] } ] }, { "description": "75600 FAC CNTRST X-RAY EXM OF AORTA", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7088.25, "discounted_cash": 2055.0, "minimum": 1174.07, "maximum": 6429.0427, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1197.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1467.59 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1174.07 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1347.88 } ] } ] }, { "description": "HC (SUP SHELL C1726) CATHETER BALLOON DILAT NON-VASCULAR", "code_information": [ { "code": "C1726", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 259.12, "10th_percentile": 259.12, "90th_percentile": 325.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 2730.57, "10th_percentile": 2730.57, "90th_percentile": 2730.57, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 13164.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9310.94 } ] } ] }, { "description": "APC Resistance", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.25, "discounted_cash": 54.0, "minimum": 54.8825, "maximum": 171.6498, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.02 }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.56, "10th_percentile": 60.56, "90th_percentile": 60.56, "count": "1 through 10" } ] } ] }, { "description": "NM Dose Sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 325.75, "minimum": 94.4675, "maximum": 325.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 325.75 } ] } ] }, { "description": "LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 16101.39, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16101.39 } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 27054.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27054.53 } ] } ] }, { "description": "CT Ankle Left w Contrast", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1735.0, "discounted_cash": 503.0, "minimum": 503.15, "maximum": 1573.645, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1321.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1056.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 527.83, "10th_percentile": 527.83, "90th_percentile": 601.7, "count": "1 through 10" }, { "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": 986.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 555.2, "10th_percentile": 473.64, "90th_percentile": 3147.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 555.2, "10th_percentile": 555.2, "90th_percentile": 555.2, "count": "1 through 10" } ] } ] }, { "description": "MRI Femur Left w+wo Contrast", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2625.0, "discounted_cash": 761.0, "minimum": 761.25, "maximum": 2625.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2625.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "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": 2083.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2625.0, "10th_percentile": 2625.0, "90th_percentile": 2625.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 971.25, "10th_percentile": 971.25, "90th_percentile": 971.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 840.0, "10th_percentile": 840.0, "90th_percentile": 840.0, "count": "1 through 10" } ] } ] }, { "description": "NM Tumor Imaging WB Multi", "code_information": [ { "code": "78804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2264.5, "discounted_cash": 656.0, "minimum": 656.705, "maximum": 2264.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 2021.92 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1982.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2264.5 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 33127.914, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7173.57, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 42640.42, "10th_percentile": 42640.42, "90th_percentile": 42640.42, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11379.9 } ] } ] }, { "description": "NM Cerebrospinal Fluid Leakage", "code_information": [ { "code": "78650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 990.0, "discounted_cash": 287.0, "minimum": 287.1, "maximum": 990.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 990.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.0 } ] } ] }, { "description": "MRI Additional 30 minutes implant 76015", "code_information": [ { "code": "76015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.5, "discounted_cash": 21.0, "minimum": 21.315, "maximum": 73.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.5 } ] } ] }, { "description": "PTT", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.75, "discounted_cash": 33.0, "minimum": 33.8575, "maximum": 105.8923, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 89.66, "10th_percentile": 89.66, "90th_percentile": 89.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.69, "10th_percentile": 39.69, "90th_percentile": 42.03, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 49.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 48.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.49, "10th_percentile": 38.24, "90th_percentile": 40.49, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 95.73, "10th_percentile": 95.73, "90th_percentile": 95.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 91.77, "10th_percentile": 88.32, "90th_percentile": 91.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 110.25, "10th_percentile": 110.25, "90th_percentile": 110.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 116.75, "10th_percentile": 110.25, "90th_percentile": 116.75, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 6.01, "90th_percentile": 37.49, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 88.12, "10th_percentile": 37.36, "90th_percentile": 106.94, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 40.79, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 74.72, "count": "19" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.36, "10th_percentile": 35.28, "90th_percentile": 37.49, "count": "13" } ] } ] }, { "description": "Stndrd Cog Perf Test HR 96125", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 240.25, "discounted_cash": 69.0, "minimum": 69.6725, "maximum": 217.9067, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51335.0, "minimum": 51335.85, "maximum": 250223.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 250223.46 } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9415.0, "minimum": 9415.31, "maximum": 18373.13, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 9415.31, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6720.0, "10th_percentile": 6720.0, "90th_percentile": 6720.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18373.13 } ] } ] }, { "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": 24883.0, "minimum": 24883.31, "maximum": 58021.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58021.82 } ] } ] }, { "description": "Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 13.0, "minimum": 13.92, "maximum": 46.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 34.37, "10th_percentile": 34.37, "90th_percentile": 34.37, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 17.28, "10th_percentile": 17.28, "90th_percentile": 17.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 38.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.65, "10th_percentile": 16.65, "90th_percentile": 16.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 30.58, "10th_percentile": 30.58, "90th_percentile": 30.58, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 38.45, "10th_percentile": 37.73, "90th_percentile": 38.45, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "17" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 48.0, "10th_percentile": 48.0, "90th_percentile": 48.0, "count": "68" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 15.36, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 17.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 15.36, "90th_percentile": 17.76, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 15.36, "10th_percentile": 4.74, "90th_percentile": 16.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 16.32, "10th_percentile": 15.36, "90th_percentile": 16.32, "count": "13" } ] } ] }, { "description": "NM Inj Non Imaging Probe Study", "code_information": [ { "code": "78808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 799.75, "discounted_cash": 231.0, "minimum": 170.18, "maximum": 725.3732, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 173.61 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 212.73 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 170.18 } ] } ] }, { "description": "Quinidine Level", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 33.0, "minimum": 33.35, "maximum": 115.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 115.0 } ] } ] }, { "description": "Pyruvate Level", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.75, "discounted_cash": 86.0, "minimum": 86.3475, "maximum": 270.0593, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 89.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.79 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 87.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.24 } ] } ] }, { "description": "Chromosome FISH, CLL Panel", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 985.25, "discounted_cash": 285.0, "minimum": 173.29, "maximum": 893.6218, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 176.77 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 173.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.57 } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27797.0, "minimum": 27797.58, "maximum": 509081.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 509081.17 } ] } ] }, { "description": "donotorder_ST GI Pan PCR", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 711.25, "discounted_cash": 206.0, "minimum": 206.2625, "maximum": 711.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 711.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 711.25 } ] } ] }, { "description": "PT Needle Insertion WO Inj 3+ Muscles Unit", "code_information": [ { "code": "20561", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 24.0, "minimum": 24.215, "maximum": 83.5, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.5 } ] } ] }, { "description": "Tetanus Ab, IgG", "code_information": [ { "code": "86774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.75, "discounted_cash": 50.0, "minimum": 50.0975, "maximum": 156.6842, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 76.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.14 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.2 } ] } ] }, { "description": "S aureus NAT - 87640 - 3150015 - 3150015", "code_information": [ { "code": "87640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 61.0, "minimum": 61.335, "maximum": 211.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 142.84, "10th_percentile": 142.84, "90th_percentile": 142.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.35, "10th_percentile": 69.19, "90th_percentile": 73.35, "count": "11" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 127.08, "10th_percentile": 127.08, "90th_percentile": 134.73, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 166.24, "10th_percentile": 159.82, "90th_percentile": 166.24, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 211.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 63.84, "90th_percentile": 67.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.74, "10th_percentile": 63.84, "90th_percentile": 191.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 73.82, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.83, "10th_percentile": 67.68, "90th_percentile": 67.83, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 63.84, "90th_percentile": 67.83, "count": "1 through 10" } ] } ] }, { "description": "CT Cervical Spine w+wo Contrast", "code_information": [ { "code": "72127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.0, "discounted_cash": 443.0, "minimum": 443.12, "maximum": 1528.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1212.52 } ] } ] }, { "description": "IV Push Each Addl New Med", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.0, "discounted_cash": 95.0, "minimum": 95.7, "maximum": 299.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 575.66, "10th_percentile": 472.56, "90th_percentile": 575.66, "count": "42" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 118.8, "10th_percentile": 118.8, "90th_percentile": 356.4, "count": "16" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 114.44, "10th_percentile": 114.44, "90th_percentile": 114.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 114.44, "10th_percentile": 114.44, "90th_percentile": 343.33, "count": "25" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 330.0, "10th_percentile": 92.74, "90th_percentile": 802.52, "count": "33" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 133.68, "10th_percentile": 133.68, "90th_percentile": 133.68, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 330.0, "10th_percentile": 330.0, "90th_percentile": 990.0, "count": "354" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.6, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "68" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 299.31, "10th_percentile": 105.6, "90th_percentile": 906.84, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 122.1, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "60" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 112.2, "10th_percentile": 105.6, "90th_percentile": 448.8, "count": "67" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 105.6, "10th_percentile": 105.6, "90th_percentile": 316.8, "count": "26" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 40389.8616, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4058.34, "10th_percentile": 4058.34, "90th_percentile": 9749.6, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 8667.69, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10317.29, "10th_percentile": 7218.72, "90th_percentile": 531182.23, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13649.44, "10th_percentile": 11699.52, "90th_percentile": 31198.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "other", "standard_charge_dollar": 8294.44, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 77555.02, "10th_percentile": 77555.02, "90th_percentile": 77555.02, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14964.93 } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 8914.83, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8914.83 } ] } ] }, { "description": "XR Bone Survey Limited", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.5, "discounted_cash": 79.0, "minimum": 79.895, "maximum": 275.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 234.89 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 275.5 } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 30599.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30599.48 } ] } ] }, { "description": "XR Single View 2 Or More Joints", "code_information": [ { "code": "77077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 312.5, "discounted_cash": 90.0, "minimum": 90.625, "maximum": 283.4375, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 107.96 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.44 } ] } ] }, { "description": "MRI Angio Chest w Contrast", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 870.0, "minimum": 870.2175, "maximum": 2721.6802, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2196.61 } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8261.72, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8261.72 } ] } ] }, { "description": "Trichomonas, Wet Mount", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70.5, "discounted_cash": 20.0, "minimum": 20.445, "maximum": 63.9435, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 47.61, "10th_percentile": 47.61, "90th_percentile": 47.61, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 56.47, "10th_percentile": 56.47, "90th_percentile": 56.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 55.41, "10th_percentile": 55.41, "90th_percentile": 55.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 70.5, "10th_percentile": 66.5, "90th_percentile": 70.5, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.56, "10th_percentile": 22.56, "90th_percentile": 22.56, "count": "1 through 10" } ] } ] }, { "description": "XR Sternoclavicular Joints Min 3 Views", "code_information": [ { "code": "71130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.75, "discounted_cash": 129.0, "minimum": 102.97, "maximum": 404.2953, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 102.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 262.24 } ] } ] }, { "description": "CMV Antibody IgM", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 290.25, "discounted_cash": 84.0, "minimum": 84.1725, "maximum": 263.2568, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 156.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 92.88, "10th_percentile": 92.88, "90th_percentile": 92.88, "count": "1 through 10" } ] } ] }, { "description": "PSA (Prostate Specific Antigen) - 84153 - 3350213", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 53.0, "minimum": 53.65, "maximum": 185.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 132.46, "10th_percentile": 132.46, "90th_percentile": 132.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.6, "10th_percentile": 66.6, "90th_percentile": 66.6, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 151.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 148.79 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.16, "10th_percentile": 64.16, "90th_percentile": 64.16, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 117.85, "10th_percentile": 117.85, "90th_percentile": 117.85, "count": "13" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 148.2, "10th_percentile": 145.41, "90th_percentile": 148.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 170.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.16, "10th_percentile": 37.44, "90th_percentile": 158.49, "count": "20" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 42.37, "10th_percentile": 42.37, "90th_percentile": 42.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 185.0, "10th_percentile": 185.0, "90th_percentile": 185.0, "count": "31" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "54" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 167.8, "10th_percentile": 59.2, "90th_percentile": 169.46, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 59.2, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "15" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.2, "10th_percentile": 59.2, "90th_percentile": 62.9, "count": "1 through 10" } ] } ] }, { "description": "MRI Pelvis w Contrast", "code_information": [ { "code": "72196", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2159.0, "discounted_cash": 626.0, "minimum": 626.11, "maximum": 2118.32, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2118.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1652.39 } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12329.0, "minimum": 12329.57, "maximum": 24961.99, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24961.99 } ] } ] }, { "description": "MRI Angio Pelvis wo 72198", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2104.0, "discounted_cash": 610.0, "minimum": 610.16, "maximum": 2104.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2104.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "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": "Calcium Level", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.0, "discounted_cash": 8.0, "minimum": 8.41, "maximum": 29.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 20.76, "10th_percentile": 20.76, "90th_percentile": 20.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.44, "10th_percentile": 10.44, "90th_percentile": 10.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.06, "10th_percentile": 10.06, "90th_percentile": 10.06, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.0, "10th_percentile": 29.0, "90th_percentile": 29.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 26.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.28, "10th_percentile": 9.28, "90th_percentile": 9.28, "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": 9191.0, "minimum": 9191.13, "maximum": 20371.36, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20371.36 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 28991.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28991.46 } ] } ] }, { "description": "XR Chest 3 Views 71047", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.25, "discounted_cash": 74.0, "minimum": 74.0225, "maximum": 248.1731, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 196.27 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 157.02 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.17 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8294.0, "minimum": 8294.44, "maximum": 48635.44, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48635.44 } ] } ] }, { "description": "EBV Capsid Ab, IgG", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.5, "discounted_cash": 52.0, "minimum": 52.345, "maximum": 168.1669, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 243.8, "10th_percentile": 243.8, "90th_percentile": 243.8, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 141.87, "10th_percentile": 141.87, "90th_percentile": 141.87, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 168.17 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 361.0, "10th_percentile": 180.5, "90th_percentile": 361.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 115.52, "10th_percentile": 115.52, "90th_percentile": 115.52, "count": "1 through 10" } ] } ] }, { "description": "Schistosoma IgG Antibody", "code_information": [ { "code": "86682", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 35.0, "minimum": 35.38, "maximum": 120.6092, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.71 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.97 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.61 } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 20622.46, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20622.46 } ] } ] }, { "description": "XR Lumbar Sp Bending 2-3V", "code_information": [ { "code": "72120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 554.5, "discounted_cash": 160.0, "minimum": 145.88, "maximum": 502.9315, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 148.81 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.35 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.88 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 253.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 502.93, "10th_percentile": 502.93, "90th_percentile": 502.93, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 177.82, "10th_percentile": 177.82, "90th_percentile": 177.82, "count": "1 through 10" } ] } ] }, { "description": "SLP Speech AAC Eval First Hour Units", "code_information": [ { "code": "92607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.5, "discounted_cash": 148.0, "minimum": 95.0, "maximum": 463.0235, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 17675.7633, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "other", "standard_charge_dollar": 6725.22, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3899.84, "10th_percentile": 3899.84, "90th_percentile": 3899.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6725.22, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12862.92, "10th_percentile": 11699.52, "90th_percentile": 48748.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12060.13 } ] } ] }, { "description": "Bill IRL Enzyme Ea Cell", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 8.0, "minimum": 8.7, "maximum": 30.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 } ] } ] }, { "description": "Antibody Titer, Blood Bank", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 239.5, "discounted_cash": 69.0, "minimum": 41.89, "maximum": 217.2265, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 } ] } ] }, { "description": "CT Temp Bones w+wo Contrast", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2012.25, "discounted_cash": 583.0, "minimum": 583.5525, "maximum": 1825.1108, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1689.29 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1351.43 }, { "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": 1328.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 605.44, "10th_percentile": 605.44, "90th_percentile": 605.44, "count": "1 through 10" } ] } ] }, { "description": "XR Knee Left 4 Views", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 504.75, "discounted_cash": 146.0, "minimum": 110.11, "maximum": 457.8082, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 341.0, "10th_percentile": 341.0, "90th_percentile": 341.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 171.45, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.64 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 110.11 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 175.05, "10th_percentile": 165.17, "90th_percentile": 175.05, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 321.53, "10th_percentile": 321.53, "90th_percentile": 321.53, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 307.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 271.92, "10th_percentile": 161.52, "90th_percentile": 319.79, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 504.75, "10th_percentile": 476.25, "90th_percentile": 504.75, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.93, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 161.52, "10th_percentile": 5.0, "90th_percentile": 436.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 30.48, "90th_percentile": 241.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.93, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.52, "10th_percentile": 152.4, "90th_percentile": 161.52, "count": "1 through 10" } ] } ] }, { "description": "Bart. henselea Ab, IgM", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.75, "discounted_cash": 16.0, "minimum": 16.7475, "maximum": 57.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 73.26, "10th_percentile": 73.26, "90th_percentile": 73.26, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 115.0, "10th_percentile": 115.0, "90th_percentile": 184.25, "count": "1 through 10" } ] } ] }, { "description": "Rad Ther Room Level 3", "code_information": [ { "code": "99213", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.25, "discounted_cash": 58.0, "minimum": 58.9425, "maximum": 184.3477, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 73.82, "10th_percentile": 73.82, "90th_percentile": 73.82, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.29, "10th_percentile": 34.29, "90th_percentile": 40.95, "count": "40" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.45, "10th_percentile": 33.04, "90th_percentile": 39.45, "count": "47" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.25, "10th_percentile": 32.39, "90th_percentile": 113.75, "count": "40" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 60.83, "10th_percentile": 59.71, "90th_percentile": 60.83, "count": "145" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 30.48, "10th_percentile": 30.48, "90th_percentile": 38.68, "count": "140" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 35.24, "10th_percentile": 8.42, "90th_percentile": 155.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.24, "10th_percentile": 6.1, "90th_percentile": 145.33, "count": "50" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.4, "10th_percentile": 30.48, "90th_percentile": 38.68, "count": "69" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.39, "10th_percentile": 30.48, "90th_percentile": 38.68, "count": "82" } ] } ] }, { "description": "Hepatitis C Antibody, IgG", "code_information": [ { "code": "86803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.25, "discounted_cash": 61.0, "minimum": 61.2625, "maximum": 191.6037, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.05, "10th_percentile": 71.73, "90th_percentile": 76.05, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 69.11, "10th_percentile": 69.11, "90th_percentile": 73.27, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.57, "10th_percentile": 126.92, "90th_percentile": 134.57, "count": "11" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 159.62, "10th_percentile": 159.62, "90th_percentile": 166.04, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.29 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 154.42, "10th_percentile": 49.1, "90th_percentile": 162.24, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.25, "10th_percentile": 199.25, "90th_percentile": 211.25, "count": "137" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 63.76, "90th_percentile": 67.6, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 182.51, "10th_percentile": 67.6, "90th_percentile": 191.6, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 63.76, "90th_percentile": 73.72, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 67.6, "90th_percentile": 67.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.6, "10th_percentile": 55.44, "90th_percentile": 67.75, "count": "18" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 142.66, "10th_percentile": 142.66, "90th_percentile": 142.66, "count": "1 through 10" } ] } ] }, { "description": "75898 FAC FOLLOW-UP ANGIOGRAPHY", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.25, "discounted_cash": 87.0, "minimum": 87.6525, "maximum": 302.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 170.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 209.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 167.33 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 302.25 } ] } ] }, { "description": "Hepatitis C RNA (Quant, RT-PCR)", "code_information": [ { "code": "87522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 474.5, "discounted_cash": 137.0, "minimum": 137.605, "maximum": 433.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 353.01, "10th_percentile": 353.01, "90th_percentile": 364.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 353.54 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 433.21 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 346.57 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 269.77, "10th_percentile": 269.77, "90th_percentile": 269.77, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 397.15 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 474.5, "10th_percentile": 423.5, "90th_percentile": 474.5, "count": "26" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.84, "10th_percentile": 143.28, "90th_percentile": 151.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 430.37, "10th_percentile": 430.37, "90th_percentile": 430.37, "count": "1 through 10" } ] } ] }, { "description": "Pinworm Prep", "code_information": [ { "code": "87172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.5, "discounted_cash": 20.0, "minimum": 20.155, "maximum": 63.0365, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.22 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.59 } ] } ] }, { "description": "Trichrome Stain, Stool", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.25, "discounted_cash": 41.0, "minimum": 41.2525, "maximum": 129.0207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 73.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.98 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 71.99 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.56, "10th_percentile": 46.56, "90th_percentile": 46.56, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 85.52, "10th_percentile": 85.52, "90th_percentile": 85.52, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 107.55, "10th_percentile": 107.55, "90th_percentile": 107.55, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.51 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 142.25, "10th_percentile": 134.25, "90th_percentile": 142.25, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 129.02, "10th_percentile": 107.31, "90th_percentile": 129.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 42.96, "10th_percentile": 42.96, "90th_percentile": 45.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 8.9, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 45.52, "10th_percentile": 45.52, "90th_percentile": 45.52, "count": "1 through 10" } ] } ] }, { "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": 3810.0, "minimum": 3810.96, "maximum": 15985.86, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15985.86 } ] } ] }, { "description": "T. Prot", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 23.0, "minimum": 23.49, "maximum": 73.467, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 18.0, "10th_percentile": 18.0, "90th_percentile": 29.16, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 40.93, "10th_percentile": 40.93, "90th_percentile": 40.93, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 81.0, "10th_percentile": 81.0, "90th_percentile": 81.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 3.67, "10th_percentile": 3.67, "90th_percentile": 3.67, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 16.0, "10th_percentile": 16.0, "90th_percentile": 28.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 24.72, "10th_percentile": 16.0, "90th_percentile": 29.97, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.54, "10th_percentile": 27.54, "90th_percentile": 27.54, "count": "1 through 10" } ] } ] }, { "description": "CU TSH", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.5, "discounted_cash": 61.0, "minimum": 61.335, "maximum": 191.8305, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 151.43, "10th_percentile": 151.43, "90th_percentile": 151.43, "count": "32" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 76.14, "10th_percentile": 76.14, "90th_percentile": 76.14, "count": "90" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.67 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.94 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 73.35, "10th_percentile": 73.35, "90th_percentile": 73.35, "count": "101" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.73, "10th_percentile": 134.73, "90th_percentile": 134.73, "count": "42" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 166.24, "10th_percentile": 166.24, "90th_percentile": 169.43, "count": "75" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 211.5, "10th_percentile": 45.92, "90th_percentile": 211.5, "count": "133" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 151.43, "10th_percentile": 49.16, "90th_percentile": 163.91, "count": "11" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.5, "10th_percentile": 211.5, "90th_percentile": 211.5, "count": "527" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "310" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 191.83, "10th_percentile": 67.68, "90th_percentile": 193.73, "count": "114" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 67.68, "count": "185" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 71.91, "count": "32" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.68, "10th_percentile": 67.68, "90th_percentile": 71.91, "count": "131" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10312.0, "minimum": 5392.2352, "maximum": 21157.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21157.68 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 18937.82, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18937.82 } ] } ] }, { "description": "Bill HIV GT Phenotype, additional", "code_information": [ { "code": "87904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.25, "discounted_cash": 30.0, "minimum": 30.2325, "maximum": 104.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.25 } ] } ] }, { "description": "Blood Culture", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200.25, "discounted_cash": 58.0, "minimum": 58.0725, "maximum": 181.6267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 270.65, "10th_percentile": 270.65, "90th_percentile": 270.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.08, "10th_percentile": 68.04, "90th_percentile": 144.18, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 104.39 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 83.51 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 138.89, "10th_percentile": 65.55, "90th_percentile": 138.89, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 157.4, "10th_percentile": 157.4, "90th_percentile": 157.4, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 378.0, "10th_percentile": 378.0, "90th_percentile": 378.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 378.0, "10th_percentile": 189.0, "90th_percentile": 400.5, "count": "45" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 120.96, "10th_percentile": 60.48, "90th_percentile": 128.16, "count": "20" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 346.25, "10th_percentile": 64.08, "90th_percentile": 363.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 69.93, "90th_percentile": 128.16, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 64.08, "90th_percentile": 128.52, "count": "21" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 128.16, "10th_percentile": 60.48, "90th_percentile": 128.52, "count": "1 through 10" } ] } ] }, { "description": "RAD HD SUBLUX CHILD FAC", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 428.75, "discounted_cash": 124.0, "minimum": 124.3375, "maximum": 388.8763, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 428.75, "10th_percentile": 428.75, "90th_percentile": 428.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18158.0, "minimum": 18158.09, "maximum": 48959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48959.63 } ] } ] }, { "description": "Fungal Culture, Tissue or Fluids", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 48.0, "minimum": 48.9375, "maximum": 153.0563, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.31 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.93 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 67.94 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 8.41, "10th_percentile": 8.41, "90th_percentile": 8.41, "count": "1 through 10" } ] } ] }, { "description": "XR Humerus Left", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413.75, "discounted_cash": 119.0, "minimum": 80.1, "maximum": 375.2713, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 317.76, "10th_percentile": 317.76, "90th_percentile": 317.76, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.95, "10th_percentile": 140.49, "90th_percentile": 148.95, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 81.71 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 80.1 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 143.49, "10th_percentile": 143.49, "90th_percentile": 143.49, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 248.59, "10th_percentile": 248.59, "90th_percentile": 248.59, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.45, "10th_percentile": 171.45, "90th_percentile": 270.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 413.75, "10th_percentile": 390.25, "90th_percentile": 413.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 124.88, "10th_percentile": 124.88, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 357.47, "10th_percentile": 357.47, "90th_percentile": 357.47, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.4, "10th_percentile": 132.4, "90th_percentile": 132.4, "count": "1 through 10" } ] } ] }, { "description": "Bill IBD sgi DNAse Sensitivity", "code_information": [ { "code": "88350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.75, "discounted_cash": 57.0, "minimum": 57.6375, "maximum": 198.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 198.75 } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 8900.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8900.68 } ] } ] }, { "description": "Ultrasound Guidance Needle Placement", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 788.0, "discounted_cash": 228.0, "minimum": 228.52, "maximum": 741.82, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 605.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 741.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 593.46 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.7 } ] } ] }, { "description": "Chemo IV Infusion 0 - 1 Hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1159.25, "discounted_cash": 336.0, "minimum": 336.1825, "maximum": 1051.4398, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 417.33, "10th_percentile": 417.33, "90th_percentile": 417.33, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 742.38, "10th_percentile": 720.58, "90th_percentile": 742.38, "count": "44" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 382.87, "10th_percentile": 382.87, "90th_percentile": 402.03, "count": "18" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 928.56, "10th_percentile": 905.28, "90th_percentile": 928.56, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1159.25, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "25" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1104.0, "10th_percentile": 1104.0, "90th_percentile": 1159.25, "count": "50" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 375.36, "count": "37" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 370.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 408.48, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 370.96, "90th_percentile": 375.36, "count": "33" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 370.96, "10th_percentile": 353.28, "90th_percentile": 375.36, "count": "32" } ] } ] }, { "description": "99281 - Level 1 - Lynx Visit Level", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.75, "discounted_cash": 73.0, "minimum": 73.0075, "maximum": 251.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 78.84, "10th_percentile": 78.84, "90th_percentile": 78.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 251.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 251.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 251.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 8.53, "10th_percentile": 8.53, "90th_percentile": 8.53, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 197.88, "10th_percentile": 197.88, "90th_percentile": 197.88, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 175.05, "10th_percentile": 175.05, "90th_percentile": 175.05, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 139.12, "10th_percentile": 74.46, "90th_percentile": 186.8, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 251.75, "10th_percentile": 219.0, "90th_percentile": 251.75, "count": "45" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.56, "10th_percentile": 73.01, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 80.56, "10th_percentile": 80.56, "90th_percentile": 228.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.56, "10th_percentile": 80.56, "90th_percentile": 81.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 80.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 70.08, "count": "1 through 10" } ] } ] }, { "description": "Leuprolide Acetate (3 Month) For Subcutaneous Inj Kit 22.5MG", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "62935022710", "type": "NDC" }, { "code": "J9217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 2847.34, "10th_percentile": 2847.34, "90th_percentile": 2847.34, "count": "1 through 10" } ] } ] }, { "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": 5156.0, "minimum": 5156.0, "maximum": 19515.48, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19515.48 } ] } ] }, { "description": "XR Abdomen 2 Views 74019", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 615.25, "discounted_cash": 178.0, "minimum": 88.83, "maximum": 558.0317, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 472.51, "10th_percentile": 472.51, "90th_percentile": 472.51, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 208.98, "10th_percentile": 208.98, "90th_percentile": 221.49, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.72 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 134.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 219.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 196.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 615.25, "10th_percentile": 615.25, "90th_percentile": 615.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 214.79, "10th_percentile": 214.79, "90th_percentile": 214.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.76, "10th_percentile": 39.38, "90th_percentile": 196.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 196.88, "10th_percentile": 196.88, "90th_percentile": 197.37, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 197.37, "10th_percentile": 197.37, "90th_percentile": 197.37, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH STERILIZATION ANDOR D&C WITHOUT CCMCC", "code_information": [ { "code": "798", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 11283.23, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11283.23 } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15916.0, "minimum": 15916.35, "maximum": 32904.22, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32904.22 } ] } ] }, { "description": "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 17529.03, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17529.03 } ] } ] }, { "description": "$ Basic Metabolic 80048", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.25, "discounted_cash": 52.0, "minimum": 52.5625, "maximum": 164.3938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 122.44, "10th_percentile": 122.44, "90th_percentile": 122.44, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 65.25, "10th_percentile": 61.56, "90th_percentile": 65.25, "count": "67" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 69.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.62 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 68.49 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 62.86, "10th_percentile": 59.3, "90th_percentile": 62.86, "count": "70" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 115.46, "10th_percentile": 108.93, "90th_percentile": 145.18, "count": "14" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 136.99, "10th_percentile": 136.99, "90th_percentile": 142.46, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.02, "10th_percentile": 25.68, "90th_percentile": 181.25, "count": "52" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 39.75, "10th_percentile": 39.16, "90th_percentile": 132.53, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 181.25, "10th_percentile": 171.0, "90th_percentile": 181.25, "count": "218" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 8.46, "90th_percentile": 58.0, "count": "197" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 164.39, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.0, "count": "116" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.14, "count": "37" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.0, "10th_percentile": 54.72, "90th_percentile": 58.14, "count": "91" } ] } ] }, { "description": "OT Biofeedback Training 1st 15min units", "code_information": [ { "code": "90912", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.5, "discounted_cash": 43.0, "minimum": 43.645, "maximum": 136.5035, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MA Breast Diag Tomo Bilat 77066 77062", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 602.75, "discounted_cash": 174.0, "minimum": 174.7975, "maximum": 602.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 170.91, "10th_percentile": 170.91, "90th_percentile": 170.91, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 492.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 164.65, "10th_percentile": 164.65, "90th_percentile": 164.65, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 302.42, "10th_percentile": 302.42, "90th_percentile": 302.42, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 373.15, "10th_percentile": 373.15, "90th_percentile": 380.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 602.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.42, "10th_percentile": 151.92, "90th_percentile": 318.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.23, "10th_percentile": 103.23, "90th_percentile": 103.23, "count": "15" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 161.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 175.66, "10th_percentile": 175.66, "90th_percentile": 430.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.92, "10th_percentile": 151.92, "90th_percentile": 151.92, "count": "1 through 10" } ] } ] }, { "description": "CT Head Code Stroke", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1560.25, "discounted_cash": 452.0, "minimum": 452.4725, "maximum": 1415.1468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 823.29, "10th_percentile": 198.8, "90th_percentile": 1022.09, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 529.92, "10th_percentile": 256.95, "90th_percentile": 544.77, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 866.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 693.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 510.49, "10th_percentile": 495.06, "90th_percentile": 524.8, "count": "16" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1143.57, "10th_percentile": 1143.57, "90th_percentile": 1189.41, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 583.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 44.42, "90th_percentile": 1366.99, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1106.31, "10th_percentile": 1106.31, "90th_percentile": 1106.31, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1513.25, "10th_percentile": 1427.5, "90th_percentile": 1513.25, "count": "97" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 484.24, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1307.59, "10th_percentile": 484.24, "90th_percentile": 1429.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 528.18, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 456.8, "90th_percentile": 485.35, "count": "43" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 484.24, "10th_percentile": 484.24, "90th_percentile": 485.35, "count": "22" } ] } ] }, { "description": "OTITIS MEDIA AND URI WITHOUT MCC", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 8702.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8702.63 } ] } ] }, { "description": "REPLACE GTUBE PERCUT NO REV TRC FAC", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1041.5, "discounted_cash": 302.0, "minimum": 302.035, "maximum": 944.6405, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1041.5, "10th_percentile": 1041.5, "90th_percentile": 1041.5, "count": "1 through 10" } ] } ] }, { "description": "C. pneumoniae Antibody, IgG", "code_information": [ { "code": "86631", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.75, "discounted_cash": 22.0, "minimum": 22.8375, "maximum": 78.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.75 } ] } ] }, { "description": "Homovanillic Acid, 24 hr Urine", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.5, "discounted_cash": 133.0, "minimum": 133.255, "maximum": 416.7665, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.69 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 207.75 } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "582", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 22712.65, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22712.65 } ] } ] }, { "description": "Methylenetetrahydrofolate Mutation", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410.75, "discounted_cash": 119.0, "minimum": 119.1175, "maximum": 410.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 260.83 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 319.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 255.69 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.75 } ] } ] }, { "description": "CT Angiography Neck w+wo Contrast", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1521.0, "discounted_cash": 441.0, "minimum": 441.09, "maximum": 1521.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1027.46, "10th_percentile": 1027.46, "90th_percentile": 1027.46, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 273.78, "10th_percentile": 258.3, "90th_percentile": 273.78, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1521.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 497.66, "10th_percentile": 497.66, "90th_percentile": 527.48, "count": "1 through 10" }, { "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": 1521.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 685.66, "10th_percentile": 685.66, "90th_percentile": 923.82, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1521.0, "10th_percentile": 1435.0, "90th_percentile": 1521.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 459.2, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1314.46, "10th_percentile": 486.72, "90th_percentile": 1393.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 486.72, "10th_percentile": 459.2, "90th_percentile": 486.72, "count": "1 through 10" } ] } ] }, { "description": "96374 - ED IV Push INITL or Single", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 506.5, "discounted_cash": 146.0, "minimum": 146.885, "maximum": 459.3955, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 280.85, "10th_percentile": 280.85, "90th_percentile": 362.65, "count": "43" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 182.34, "10th_percentile": 182.34, "90th_percentile": 182.34, "count": "26" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 175.65, "10th_percentile": 175.65, "90th_percentile": 324.36, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 175.65, "10th_percentile": 175.65, "90th_percentile": 175.65, "count": "31" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 398.11, "10th_percentile": 398.11, "90th_percentile": 398.11, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 282.95, "10th_percentile": 83.5, "90th_percentile": 506.5, "count": "29" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 205.18, "10th_percentile": 205.18, "90th_percentile": 388.99, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 506.5, "10th_percentile": 506.5, "90th_percentile": 506.5, "count": "438" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 162.08, "count": "87" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 459.4, "10th_percentile": 162.08, "90th_percentile": 463.95, "count": "32" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 187.41, "count": "85" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 172.21, "count": "63" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 162.08, "10th_percentile": 162.08, "90th_percentile": 172.21, "count": "26" } ] } ] }, { "description": "NM MUGA Gated Cardiac Multi Planar", "code_information": [ { "code": "78473", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2219.75, "discounted_cash": 643.0, "minimum": 643.7275, "maximum": 2013.3132, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1120.4 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1372.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1098.29 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1700.33 } ] } ] }, { "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": 76.8, "median_amount": 135.04, "10th_percentile": 135.04, "90th_percentile": 135.04, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 697.41, "10th_percentile": 697.41, "90th_percentile": 697.41, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.9, "10th_percentile": 121.9, "90th_percentile": 121.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1143.25, "10th_percentile": 1143.25, "90th_percentile": 1143.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 365.84, "10th_percentile": 341.92, "90th_percentile": 731.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 4552.59, "10th_percentile": 4246.27, "90th_percentile": 6003.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 365.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.25, "10th_percentile": 59.25, "90th_percentile": 59.25, "count": "1 through 10" } ] } ] }, { "description": "Drug Monitoring, Phosphatatidylethanol (Peth), Blood - G0480 - 3351254", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 382.5, "minimum": 81.8525, "maximum": 382.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 344.75, "10th_percentile": 325.25, "90th_percentile": 344.75, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 173.49, "10th_percentile": 173.49, "90th_percentile": 173.49, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 432.75, "10th_percentile": 164.25, "90th_percentile": 1052.5, "count": "14" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.76, "10th_percentile": 95.76, "90th_percentile": 95.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 363.48, "10th_percentile": 363.48, "90th_percentile": 375.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.48, "10th_percentile": 132.48, "90th_percentile": 257.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 132.77, "10th_percentile": 132.77, "90th_percentile": 337.54, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 55.85, "10th_percentile": 55.85, "90th_percentile": 55.85, "count": "1 through 10" } ] } ] }, { "description": "XR Sm Int F-Thru Std 74248", "code_information": [ { "code": "74248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 943.75, "discounted_cash": 273.0, "minimum": 273.6875, "maximum": 855.9813, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.13 } ] } ] }, { "description": "Vaginal Screen, Candida sp", "code_information": [ { "code": "87480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.5, "discounted_cash": 18.0, "minimum": 18.995, "maximum": 65.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 44.21, "10th_percentile": 44.21, "90th_percentile": 44.21, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 23.58, "10th_percentile": 22.23, "90th_percentile": 23.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 22.72, "10th_percentile": 22.72, "90th_percentile": 22.72, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 39.33, "10th_percentile": 39.33, "90th_percentile": 41.72, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 51.48, "10th_percentile": 49.47, "90th_percentile": 51.48, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.5 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 24.06, "10th_percentile": 24.06, "90th_percentile": 24.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.5, "10th_percentile": 61.75, "90th_percentile": 65.5, "count": "127" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 59.41, "10th_percentile": 52.35, "90th_percentile": 59.41, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.76, "10th_percentile": 19.76, "90th_percentile": 20.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 20.96, "10th_percentile": 20.96, "90th_percentile": 21.0, "count": "1 through 10" } ] } ] }, { "description": "93242 F EXT ECG>48HR<7D RECORDING", "code_information": [ { "code": "93242", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.25, "discounted_cash": 18.0, "minimum": 18.3425, "maximum": 57.3678, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 40.51, "10th_percentile": 40.51, "90th_percentile": 40.51, "count": "1 through 10" } ] } ] }, { "description": "Ceftriaxone Sodium For Inj 2 GM", "drug_information": { "unit": 1.0, "type": "EA" }, "code_information": [ { "code": "60505614900", "type": "NDC" }, { "code": "J0696", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 12.77, "10th_percentile": 12.77, "90th_percentile": 12.77, "count": "1 through 10" } ] } ] }, { "description": "MA US Elastography 1st Lesion 76982", "code_information": [ { "code": "76982", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.0, "discounted_cash": 157.0, "minimum": 157.18, "maximum": 542.0, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 542.0 } ] } ] }, { "description": "RESPIRATORY NEOPLASMS WITH CC", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12626.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12626.0 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10984.0, "minimum": 10984.53, "maximum": 23203.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23203.07 } ] } ] }, { "description": "Thyroglobulin Ab", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.75, "discounted_cash": 55.0, "minimum": 55.3175, "maximum": 173.0103, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.8, "10th_percentile": 64.8, "90th_percentile": 68.67, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 115.1 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 112.83 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 66.16, "10th_percentile": 66.16, "90th_percentile": 66.16, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 147.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 180.0, "10th_percentile": 180.0, "90th_percentile": 190.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 57.6, "10th_percentile": 57.6, "90th_percentile": 61.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 173.01, "10th_percentile": 173.01, "90th_percentile": 173.01, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24659.0, "minimum": 24659.14, "maximum": 90129.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90129.11 } ] } ] }, { "description": "ED OB US LIMITED FETUS(S) FAC", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 542.25, "discounted_cash": 157.0, "minimum": 157.2525, "maximum": 491.8207, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 287.82 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 230.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 428.6 } ] } ] }, { "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": 9639.0, "minimum": 9639.48, "maximum": 77516.08, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77516.08 } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 8352.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8352.49 } ] } ] }, { "description": "MRI Thoracic Spine w+wo Contrast", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2556.5, "discounted_cash": 741.0, "minimum": 741.385, "maximum": 2556.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2556.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2136.55 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1880.76 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 2556.5, "10th_percentile": 2556.5, "90th_percentile": 2556.5, "count": "1 through 10" } ] } ] }, { "description": ".Hexagonal Phase Confirm", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.75, "discounted_cash": 28.0, "minimum": 28.9275, "maximum": 99.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.51 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 36.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.6, "10th_percentile": 34.6, "90th_percentile": 34.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.75 } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5156.0, "minimum": 5156.0, "maximum": 12964.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12964.34 } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 12659.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12659.01 } ] } ] }, { "description": "PTA Team Conference 30 Min Pt Present Unit", "code_information": [ { "code": "99366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.75, "discounted_cash": 39.0, "minimum": 39.3675, "maximum": 123.1252, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "MA Galactogram Single Duct Right Digital", "code_information": [ { "code": "77053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.5, "discounted_cash": 123.0, "minimum": 123.685, "maximum": 386.8355, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 236.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 289.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 231.68 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 312.98 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 20580.201, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6276.87, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8575.28, "10th_percentile": 8575.28, "90th_percentile": 8575.28, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11910.41 } ] } ] }, { "description": "CT Angiography Head w+wo Contrast", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1528.0, "discounted_cash": 443.0, "minimum": 443.12, "maximum": 1528.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1032.11, "10th_percentile": 1032.11, "90th_percentile": 1032.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 550.08, "10th_percentile": 518.94, "90th_percentile": 550.08, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1395.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 249.91, "10th_percentile": 249.91, "90th_percentile": 529.91, "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": 78.6, "median_amount": 1154.79, "10th_percentile": 1154.79, "90th_percentile": 1201.01, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1528.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1528.0, "10th_percentile": 1441.5, "90th_percentile": 1528.0, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 461.28, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 1320.41, "10th_percentile": 488.96, "90th_percentile": 1399.65, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 488.96, "10th_percentile": 461.28, "90th_percentile": 488.96, "count": "1 through 10" } ] } ] }, { "description": "NM Myocardial SPECT Single", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3984.25, "discounted_cash": 1155.0, "minimum": 616.37, "maximum": 3613.7148, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 628.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 770.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 616.37 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2114.87 } ] } ] }, { "description": "C3 (Complement C3)", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.75, "discounted_cash": 37.0, "minimum": 37.9175, "maximum": 118.5902, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 147.5, "10th_percentile": 147.5, "90th_percentile": 147.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.37, "10th_percentile": 44.37, "90th_percentile": 44.37, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.03 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.77 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 90.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 130.75, "10th_percentile": 123.25, "90th_percentile": 206.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.84, "10th_percentile": 39.44, "90th_percentile": 83.68, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 39.44, "10th_percentile": 39.44, "90th_percentile": 39.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.84, "10th_percentile": 39.44, "90th_percentile": 41.84, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 41.84, "10th_percentile": 41.84, "90th_percentile": 83.68, "count": "1 through 10" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28021.0, "minimum": 28021.75, "maximum": 128194.55, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 128194.55 } ] } ] }, { "description": "DHEA", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.5, "discounted_cash": 84.0, "minimum": 84.535, "maximum": 264.3905, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 104.94, "10th_percentile": 104.94, "90th_percentile": 104.94, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 208.6 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 255.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 204.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.27 } ] } ] }, { "description": "PULMONARY EDEMA AND RESPIRATORY FAILURE", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7846.0, "minimum": 5853.0076, "maximum": 14564.11, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7846.09, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 10719.1, "10th_percentile": 10719.1, "90th_percentile": 10719.1, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14564.11 } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57836.0, "minimum": 57836.89, "maximum": 330373.2, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 330373.2 } ] } ] }, { "description": "Pregnenolone, LC/MS/MS", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.5, "discounted_cash": 24.0, "minimum": 24.795, "maximum": 85.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 85.5 } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4707.0, "minimum": 4707.65, "maximum": 11267.91, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11267.91 } ] } ] }, { "description": "XR ERCP Biliary", "code_information": [ { "code": "74328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1545.75, "discounted_cash": 448.0, "minimum": 448.2675, "maximum": 1401.9952, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 517.87 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 634.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 507.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.34 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 22763.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22763.34 } ] } ] }, { "description": "HIV-1,2 Confirmation", "code_information": [ { "code": "86689", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.75, "discounted_cash": 75.0, "minimum": 75.3275, "maximum": 235.5933, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 259.75, "10th_percentile": 245.0, "90th_percentile": 259.75, "count": "1 through 10" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 15282.05, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 10073.27, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 3994.07, "10th_percentile": 3994.07, "90th_percentile": 3994.07, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15282.05 } ] } ] }, { "description": "Creatine Kinase MB", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.25, "discounted_cash": 60.0, "minimum": 60.9725, "maximum": 190.6968, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 62.73 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.28, "10th_percentile": 67.28, "90th_percentile": 67.28, "count": "1 through 10" } ] } ] }, { "description": "LD (Lactate Dehydrogenase)", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 29.0, "minimum": 29.58, "maximum": 92.514, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 36.72, "10th_percentile": 36.72, "90th_percentile": 36.72, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.03 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.37, "10th_percentile": 35.37, "90th_percentile": 35.37, "count": "12" }, { "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": 81.7, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "12" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 102.0, "10th_percentile": 102.0, "90th_percentile": 102.0, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "27" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 81.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 264.01, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 34.68, "count": "16" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.64, "10th_percentile": 32.64, "90th_percentile": 32.64, "count": "1 through 10" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 18766.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18766.88 } ] } ] }, { "description": "NM Venous Thrombosis Unilateral", "code_information": [ { "code": "78457", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 233.0, "minimum": 233.015, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 593.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 727.55 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 582.04 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "RSV, PCR", "code_information": [ { "code": "87634", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.75, "discounted_cash": 61.0, "minimum": 61.4075, "maximum": 211.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 143.02, "10th_percentile": 143.02, "90th_percentile": 143.02, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 163.79, "10th_percentile": 163.79, "90th_percentile": 163.79, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 211.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 211.75, "10th_percentile": 199.75, "90th_percentile": 211.75, "count": "22" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 159.66, "10th_percentile": 159.66, "90th_percentile": 159.66, "count": "1 through 10" } ] } ] }, { "description": "RAD ULNAR SHAFT FX FAC", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.75, "discounted_cash": 102.0, "minimum": 102.8775, "maximum": 321.7582, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 354.75, "10th_percentile": 354.75, "90th_percentile": 354.75, "count": "1 through 10" } ] } ] }, { "description": "N-Telopeptide Cross-Linked, Urine", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.5, "discounted_cash": 72.0, "minimum": 72.645, "maximum": 227.2035, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.91 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 103.13 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.17 } ] } ] }, { "description": "MRI Ankle Left w+wo Contrast", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3000.75, "discounted_cash": 870.0, "minimum": 870.2175, "maximum": 2721.6802, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2668.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "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": 2503.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 3000.75, "10th_percentile": 3000.75, "90th_percentile": 3000.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 1020.26, "10th_percentile": 1020.26, "90th_percentile": 1020.26, "count": "1 through 10" } ] } ] }, { "description": "SLP Eval of Speech Sound Prod Units", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 347.0, "discounted_cash": 100.0, "minimum": 95.0, "maximum": 314.729, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "SLP Group Therapy Units", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.5, "discounted_cash": 79.0, "minimum": 79.605, "maximum": 248.9715, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "XR Sacrum and Coccyx Min 2 Views", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.5, "discounted_cash": 150.0, "minimum": 81.52, "maximum": 469.3725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 175.77, "10th_percentile": 175.77, "90th_percentile": 186.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.9 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.83 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 517.5, "10th_percentile": 488.25, "90th_percentile": 517.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.24, "10th_percentile": 156.24, "90th_percentile": 166.01, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 469.37, "10th_percentile": 469.37, "90th_percentile": 469.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 165.6, "10th_percentile": 165.6, "90th_percentile": 165.6, "count": "1 through 10" } ] } ] }, { "description": "IL28B rs12979860", "code_information": [ { "code": "81400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.25, "discounted_cash": 175.0, "minimum": 175.8125, "maximum": 592.9412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 259.19 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 317.6 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 254.08 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 592.94 } ] } ] }, { "description": "Fetal Screen", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230.75, "discounted_cash": 66.0, "minimum": 53.7, "maximum": 209.2902, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 54.78 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 53.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.77 } ] } ] }, { "description": "Angiotensin Converting Enzyme, Serum", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.75, "discounted_cash": 64.0, "minimum": 64.8875, "maximum": 202.9412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 120.47 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 147.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 118.09 }, { "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": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 223.75, "10th_percentile": 223.75, "90th_percentile": 223.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 14.6, "10th_percentile": 14.6, "90th_percentile": 14.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.6, "10th_percentile": 71.6, "90th_percentile": 71.6, "count": "1 through 10" } ] } ] }, { "description": "BhCG Quant", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.75, "discounted_cash": 48.0, "minimum": 48.3575, "maximum": 152.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 119.39, "10th_percentile": 119.39, "90th_percentile": 119.39, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 124.26 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 152.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 121.8 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 136.74, "10th_percentile": 136.74, "90th_percentile": 136.74, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 133.58, "10th_percentile": 133.58, "90th_percentile": 133.58, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 166.75, "10th_percentile": 166.75, "90th_percentile": 166.75, "count": "121" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 152.74, "10th_percentile": 152.74, "90th_percentile": 152.74, "count": "1 through 10" } ] } ] }, { "description": "Bill HIV GT Genotype", "code_information": [ { "code": "87901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1241.0, "discounted_cash": 359.0, "minimum": 359.89, "maximum": 1241.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 679.05 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 832.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 665.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1241.0 } ] } ] }, { "description": "NM Inflamation Local Whole Body 78802", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5434.75, "discounted_cash": 1576.0, "minimum": 1079.7, "maximum": 4929.3183, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 1101.43 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1349.63 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1079.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2072.53 } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 16277.04, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16277.04 } ] } ] }, { "description": "INTUBATE ENDOTRACHEAL FAC", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 670.75, "discounted_cash": 194.0, "minimum": 194.5175, "maximum": 608.3703, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 480.26, "10th_percentile": 480.26, "90th_percentile": 480.26, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 241.47, "10th_percentile": 241.47, "90th_percentile": 241.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 232.62, "10th_percentile": 232.62, "90th_percentile": 232.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 670.75, "10th_percentile": 670.75, "90th_percentile": 670.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 214.64, "10th_percentile": 214.64, "90th_percentile": 214.64, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 16102.5179, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6793.6, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8639.35, "10th_percentile": 8639.35, "90th_percentile": 8639.35, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 6501.05, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 48748.0, "10th_percentile": 48748.0, "90th_percentile": 48748.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9916.89 } ] } ] }, { "description": "OT Orthotic Management, Initial 15", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.25, "discounted_cash": 32.0, "minimum": 32.2625, "maximum": 100.9038, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 } ] } ] }, { "description": "U ALA", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 46.0, "minimum": 46.0375, "maximum": 158.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 135.9 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 158.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 133.22 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 152.5 } ] } ] }, { "description": "Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 360.75, "discounted_cash": 104.0, "minimum": 104.6175, "maximum": 327.2002, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 246.42 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.95 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 241.56 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 276.72 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2914.0, "minimum": 2914.26, "maximum": 7474.21, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7474.21 } ] } ] }, { "description": "75726 FAC ARTERY X-RAYS, ABDOMEN", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7482.0, "discounted_cash": 2169.0, "minimum": 657.0373, "maximum": 6786.174, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 917.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1124.41 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 899.52 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 657.04 } ] } ] }, { "description": "Chemo IV Infusion Each Addl Hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.75, "discounted_cash": 72.0, "minimum": 72.1375, "maximum": 225.6163, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 159.3, "10th_percentile": 154.69, "90th_percentile": 318.6, "count": "21" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 82.19, "10th_percentile": 82.19, "90th_percentile": 82.19, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 237.0, "10th_percentile": 88.78, "90th_percentile": 711.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 237.0, "10th_percentile": 237.0, "90th_percentile": 474.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.68, "10th_percentile": 79.6, "90th_percentile": 238.8, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 17.54, "90th_percentile": 303.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 161.16, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 79.6, "10th_percentile": 75.84, "90th_percentile": 159.2, "count": "21" } ] } ] }, { "description": "Urea Nitrogen, Random Urine", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.25, "discounted_cash": 19.0, "minimum": 19.5025, "maximum": 60.9958, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 39.18 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.54 } ] } ] }, { "description": "REM FB EXT AUD CANAL FAC", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.75, "discounted_cash": 79.0, "minimum": 79.9675, "maximum": 250.1053, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 275.75, "10th_percentile": 275.75, "90th_percentile": 275.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.24, "10th_percentile": 88.24, "90th_percentile": 88.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 88.24, "10th_percentile": 88.24, "90th_percentile": 88.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 89.25, "10th_percentile": 89.25, "90th_percentile": 89.25, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 13484.24, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13484.24 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12105.0, "minimum": 12105.4, "maximum": 37042.15, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37042.15 } ] } ] }, { "description": "NM Iodine I-123 Ioflupane Up To 5 mCi", "code_information": [ { "code": "A9584", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10167.5, "minimum": 2948.575, "maximum": 10167.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10167.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 9741.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7929.68 } ] } ] }, { "description": "XR Scoliosis 6 Views Min 72084", "code_information": [ { "code": "72084", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 541.75, "discounted_cash": 157.0, "minimum": 157.1075, "maximum": 541.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.75 } ] } ] }, { "description": "US Breast Right Limited", "code_information": [ { "code": "76642", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.75, "discounted_cash": 142.0, "minimum": 142.0275, "maximum": 448.337, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 330.79, "10th_percentile": 330.79, "90th_percentile": 330.79, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 176.31, "10th_percentile": 166.32, "90th_percentile": 176.31, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.28 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 220.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 169.85, "10th_percentile": 160.22, "90th_percentile": 169.85, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 311.97, "10th_percentile": 311.97, "90th_percentile": 311.97, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 384.94, "10th_percentile": 370.11, "90th_percentile": 384.94, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 448.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 157.08, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 376.13, "10th_percentile": 376.13, "90th_percentile": 376.13, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 489.75, "10th_percentile": 462.0, "90th_percentile": 697.5, "count": "24" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 157.08, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 444.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 147.84, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 223.2, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 156.72, "10th_percentile": 156.72, "90th_percentile": 156.72, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10013.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10013.56 } ] } ] }, { "description": "HIV 1,2 Ab - 86703 - 3358933", "code_information": [ { "code": "86703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.25, "discounted_cash": 26.0, "minimum": 26.4625, "maximum": 91.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 61.58, "10th_percentile": 61.58, "90th_percentile": 61.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.4 }, { "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": 78.6, "median_amount": 68.89, "10th_percentile": 68.89, "90th_percentile": 68.89, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 91.25 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 70.08, "10th_percentile": 70.08, "90th_percentile": 70.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 91.25, "10th_percentile": 86.0, "90th_percentile": 91.25, "count": "131" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 78.78, "10th_percentile": 78.78, "90th_percentile": 82.76, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 15113.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15113.47 } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11432.0, "minimum": 11432.87, "maximum": 24859.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24859.42 } ] } ] }, { "description": "MINOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "607", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6501.0, "minimum": 6501.05, "maximum": 12948.12, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10685.53 } ] } ] }, { "description": "MRI Brain wo Contrast", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1743.0, "discounted_cash": 505.0, "minimum": 505.47, "maximum": 1726.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 1247.99, "10th_percentile": 1247.99, "90th_percentile": 1247.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 313.74, "10th_percentile": 313.74, "90th_percentile": 627.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1726.81 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1381.44 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 604.47, "10th_percentile": 604.47, "90th_percentile": 604.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 1396.32, "10th_percentile": 1396.32, "90th_percentile": 1396.32, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1119.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 205.2, "10th_percentile": 60.0, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 1338.62, "10th_percentile": 1338.62, "90th_percentile": 1338.62, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1743.0, "10th_percentile": 1743.0, "90th_percentile": 1743.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 557.76, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 557.76, "10th_percentile": 557.76, "90th_percentile": 592.62, "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": 5828.0, "minimum": 5828.52, "maximum": 11911.59, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11911.59 } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 13519.6, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13519.6 } ] } ] }, { "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": 465.0, "minimum": 465.885, "maximum": 1606.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1606.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1352.85 }, { "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 } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17037.0, "minimum": 17037.22, "maximum": 37309.76, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37309.76 } ] } ] }, { "description": "Valproic", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 48.0, "minimum": 48.72, "maximum": 152.376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 60.48, "10th_percentile": 57.06, "90th_percentile": 60.48, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.02 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 107.02, "10th_percentile": 107.02, "90th_percentile": 107.02, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.96, "10th_percentile": 7.66, "90th_percentile": 145.66, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 168.0, "10th_percentile": 158.5, "90th_percentile": 168.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.72, "10th_percentile": 13.54, "90th_percentile": 53.76, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.72, "10th_percentile": 50.72, "90th_percentile": 50.72, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.89, "10th_percentile": 53.89, "90th_percentile": 53.89, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 23180.67, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23180.67 } ] } ] }, { "description": "75820 FAC VENOGRAPHY EXT UNILATERAL", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2650.75, "discounted_cash": 768.0, "minimum": 324.62, "maximum": 2404.2303, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 331.16 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 405.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 324.62 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.95 } ] } ] }, { "description": "Candida albicans Ab.IgG", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.0, "discounted_cash": 10.0, "minimum": 10.15, "maximum": 35.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.0 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 10059.54, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10059.54 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 22287.07, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22287.07 } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 22832.9, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22832.9 } ] } ] }, { "description": "RMV DEVL TIS 20 CM /< FAC", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.75, "discounted_cash": 55.0, "minimum": 55.8975, "maximum": 174.8243, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 65.19, "10th_percentile": 65.19, "90th_percentile": 65.19, "count": "1 through 10" } ] } ] }, { "description": "Thyroxine, Total (T4)", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.25, "discounted_cash": 31.0, "minimum": 31.1025, "maximum": 97.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 82.37, "10th_percentile": 82.37, "90th_percentile": 83.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 69.48 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.58 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 37.2, "10th_percentile": 37.2, "90th_percentile": 37.2, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.69 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 107.25, "10th_percentile": 107.25, "90th_percentile": 107.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 6.87, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 34.32, "10th_percentile": 34.32, "90th_percentile": 34.32, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12553.0, "minimum": 12553.74, "maximum": 22048.93, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22048.93 } ] } ] }, { "description": "36591 COLLECT FROM VAD", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 9.0, "minimum": 9.135, "maximum": 28.5705, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.4, "10th_percentile": 10.4, "90th_percentile": 10.92, "count": "15" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 31.5, "10th_percentile": 31.5, "90th_percentile": 31.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 31.5, "10th_percentile": 30.0, "90th_percentile": 31.5, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "35" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 9.6, "10th_percentile": 9.6, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 10.08, "90th_percentile": 10.2, "count": "12" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 10.08, "10th_percentile": 9.6, "90th_percentile": 10.2, "count": "14" } ] } ] }, { "description": "Galectin-3, Serum", "code_information": [ { "code": "82777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 294.5, "discounted_cash": 85.0, "minimum": 85.405, "maximum": 294.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 100.63 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 98.64 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 294.5 } ] } ] }, { "description": "5 Nucleotidase", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 33.0, "minimum": 33.93, "maximum": 112.84, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 92.09 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.84 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 90.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 103.37 } ] } ] }, { "description": "Cardiolipin Ab, IgG", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 338.0, "discounted_cash": 98.0, "minimum": 98.02, "maximum": 306.566, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.02 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.22 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 234.44, "10th_percentile": 234.44, "90th_percentile": 234.44, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 956.25, "10th_percentile": 318.75, "90th_percentile": 1275.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 108.16, "10th_percentile": 108.16, "90th_percentile": 108.16, "count": "1 through 10" } ] } ] }, { "description": "ROM Extremity/Trunk Excluded OT", "code_information": [ { "code": "95851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.75, "discounted_cash": 18.0, "minimum": 18.7775, "maximum": 64.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.75 } ] } ] }, { "description": "Hepatitis Be Antigen", "code_information": [ { "code": "87350", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.25, "discounted_cash": 31.0, "minimum": 31.6825, "maximum": 109.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 95.14 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 93.27 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 106.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 109.25, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.96, "10th_percentile": 32.96, "90th_percentile": 32.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 99.09, "10th_percentile": 99.09, "90th_percentile": 99.09, "count": "1 through 10" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 12279.4, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12279.4 } ] } ] }, { "description": "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC", "code_information": [ { "code": "040", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16140.0, "minimum": 16140.53, "maximum": 45519.61, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45519.61 } ] } ] }, { "description": "PFT Full", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 461.5, "discounted_cash": 133.0, "minimum": 133.835, "maximum": 418.5805, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 166.14, "10th_percentile": 158.22, "90th_percentile": 166.14, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 295.55, "10th_percentile": 278.7, "90th_percentile": 295.55, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.05, "10th_percentile": 152.42, "90th_percentile": 160.05, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 350.14, "10th_percentile": 350.14, "90th_percentile": 350.14, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 342.07, "10th_percentile": 342.07, "90th_percentile": 352.08, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 368.88, "10th_percentile": 368.88, "90th_percentile": 368.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 461.5, "10th_percentile": 427.0, "90th_percentile": 461.5, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 136.64, "90th_percentile": 147.68, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 341.3, "10th_percentile": 27.33, "90th_percentile": 418.58, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 29.54, "10th_percentile": 25.0, "90th_percentile": 136.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 147.68, "90th_percentile": 147.68, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 147.68, "10th_percentile": 145.18, "90th_percentile": 147.68, "count": "1 through 10" } ] } ] }, { "description": "Bill Parasite Conc", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.5, "discounted_cash": 24.0, "minimum": 24.215, "maximum": 75.7345, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.12 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.54 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 54.03 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 83.5, "10th_percentile": 83.5, "90th_percentile": 83.5, "count": "1 through 10" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 10304.75, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10304.75 } ] } ] }, { "description": "XR Facial Bones 3-4 Views", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 132.0, "minimum": 115.82, "maximum": 413.8188, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 118.15 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.82 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.05 } ] } ] }, { "description": "Tetanus-Diphtheria Toxoids (Td) Inj 5-2 LF/0.5ML", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "49281021515", "type": "NDC" }, { "code": "90714", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 67.23, "10th_percentile": 67.23, "90th_percentile": 67.23, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 153.13, "10th_percentile": 153.13, "90th_percentile": 153.13, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 186.74, "10th_percentile": 186.74, "90th_percentile": 186.74, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 59.76, "10th_percentile": 59.76, "90th_percentile": 59.76, "count": "1 through 10" } ] } ] }, { "description": "Lyme IgG, Western Blot", "code_information": [ { "code": "86617", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 32.0, "minimum": 32.335, "maximum": 111.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 134.09, "10th_percentile": 134.09, "90th_percentile": 134.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 223.0, "10th_percentile": 210.5, "90th_percentile": 223.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.36, "10th_percentile": 67.36, "90th_percentile": 71.57, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 71.36, "10th_percentile": 71.36, "90th_percentile": 71.36, "count": "1 through 10" } ] } ] }, { "description": "XR ERCP Pancreatic", "code_information": [ { "code": "74329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2007.5, "discounted_cash": 582.0, "minimum": 265.98, "maximum": 1820.8025, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 271.33 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 332.48 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 265.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 360.92 } ] } ] }, { "description": "Protein Electrophoresis, 24-Hour Urine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 23.0, "minimum": 23.345, "maximum": 73.0135, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 57.64, "10th_percentile": 57.64, "90th_percentile": 57.64, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 28.98, "10th_percentile": 28.98, "90th_percentile": 28.98, "count": "45" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 42.74 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.37 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 41.89 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 27.92, "10th_percentile": 27.92, "90th_percentile": 27.92, "count": "44" }, { "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": 102.56, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 63.27, "10th_percentile": 63.27, "90th_percentile": 64.49, "count": "14" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 80.5, "10th_percentile": 10.96, "90th_percentile": 80.5, "count": "53" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 18.71, "10th_percentile": 18.71, "90th_percentile": 18.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 80.5, "10th_percentile": 80.5, "90th_percentile": 80.5, "count": "59" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 27.37, "count": "114" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 73.74, "count": "45" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 29.79, "count": "81" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 25.76, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 25.76, "10th_percentile": 25.76, "90th_percentile": 27.37, "count": "61" } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "821", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 26390.81, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26390.81 } ] } ] }, { "description": "Community Work Training/15 min OT", "code_information": [ { "code": "97537", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.75, "discounted_cash": 26.0, "minimum": 26.3175, "maximum": 90.75, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.75 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5604.0, "minimum": 5604.35, "maximum": 12694.8522, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 5604.35, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4480.0, "10th_percentile": 4480.0, "90th_percentile": 12300.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9190.69 } ] } ] }, { "description": "Magnesium Sulfate Inj 50%", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323006401", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 124.7, "10th_percentile": 124.7, "90th_percentile": 124.7, "count": "1 through 10" } ] } ] }, { "description": "IR Hepatic Portogram wo Press 75885", "code_information": [ { "code": "75885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7643.0, "discounted_cash": 2216.0, "minimum": 611.8963, "maximum": 6932.201, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 846.11 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1036.78 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 829.42 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 611.9 } ] } ] }, { "description": "Chloride, Stool", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.25, "discounted_cash": 21.0, "minimum": 21.8225, "maximum": 68.2518, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 40.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.46 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 39.57 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.35 } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13674.0, "minimum": 13674.61, "maximum": 42139.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42139.71 } ] } ] }, { "description": "99282 - Level 2 - Lynx Visit Level", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.5, "discounted_cash": 121.0, "minimum": 121.365, "maximum": 418.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 260.62, "10th_percentile": 119.42, "90th_percentile": 282.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.04, "10th_percentile": 131.04, "90th_percentile": 150.66, "count": "22" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "case rate", "standard_charge_dollar": 418.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "case rate", "standard_charge_dollar": 418.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 418.5 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 126.24, "10th_percentile": 126.24, "90th_percentile": 145.14, "count": "17" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 80.1, "median_amount": 298.48, "10th_percentile": 298.48, "90th_percentile": 612.74, "count": "16" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 291.6, "10th_percentile": 291.6, "90th_percentile": 328.94, "count": "12" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 79.93, "median_amount": 334.51, "10th_percentile": 334.51, "90th_percentile": 334.51, "count": "1 through 10" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 200.18, "count": "40" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 282.1, "10th_percentile": 149.01, "90th_percentile": 321.41, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 418.5, "10th_percentile": 364.0, "90th_percentile": 418.5, "count": "733" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 123.76, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "74" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 333.42, "10th_percentile": 133.92, "90th_percentile": 379.58, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "46" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "38" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 133.92, "10th_percentile": 116.48, "90th_percentile": 133.92, "count": "19" } ] } ] }, { "description": "IR Mech Removal Pericath OBS-CVAD", "code_information": [ { "code": "75901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1044.75, "discounted_cash": 302.0, "minimum": 302.9775, "maximum": 1044.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 602.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 738.26 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 590.6 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1044.75 } ] } ] }, { "description": "88304 AP Bill Surgical Pathology Level III Complexity", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.0, "discounted_cash": 86.0, "minimum": 86.13, "maximum": 297.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 106.92, "10th_percentile": 106.92, "90th_percentile": 213.84, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 190.2, "10th_percentile": 190.2, "90th_percentile": 193.85, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 103.0, "10th_percentile": 103.0, "90th_percentile": 103.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 297.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 297.0, "10th_percentile": 297.0, "90th_percentile": 297.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.04, "10th_percentile": 95.04, "90th_percentile": 95.04, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 272.05, "10th_percentile": 272.05, "90th_percentile": 272.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.04, "10th_percentile": 95.04, "90th_percentile": 95.04, "count": "1 through 10" } ] } ] }, { "description": ".Antinuclear Abs Titer and Pattern", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.0, "discounted_cash": 10.0, "minimum": 10.73, "maximum": 37.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 28.42, "10th_percentile": 28.42, "90th_percentile": 28.42, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.83, "10th_percentile": 12.83, "90th_percentile": 12.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 37.0, "10th_percentile": 35.0, "90th_percentile": 37.0, "count": "19" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.2, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 11.84, "10th_percentile": 11.2, "90th_percentile": 11.84, "count": "1 through 10" } ] } ] }, { "description": "Vitamin D 25-Hydroxy Level", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.25, "discounted_cash": 32.0, "minimum": 32.5525, "maximum": 112.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 80.37, "10th_percentile": 80.37, "90th_percentile": 80.37, "count": "11" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 40.41, "10th_percentile": 40.41, "90th_percentile": 40.41, "count": "31" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 38.93, "10th_percentile": 38.93, "90th_percentile": 38.93, "count": "25" }, { "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": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 88.23, "10th_percentile": 88.23, "90th_percentile": 89.92, "count": "22" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 112.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 95.14, "10th_percentile": 14.16, "90th_percentile": 112.25, "count": "16" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 26.09, "10th_percentile": 26.09, "90th_percentile": 80.37, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 112.25, "10th_percentile": 112.25, "90th_percentile": 112.25, "count": "208" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "65" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 89.72, "10th_percentile": 35.92, "90th_percentile": 102.82, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 35.92, "count": "62" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 38.17, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 35.92, "10th_percentile": 35.92, "90th_percentile": 38.17, "count": "29" } ] } ] }, { "description": "88142 AP Bill Gyn Cytology Liquid Prep Dx", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.75, "discounted_cash": 42.0, "minimum": 42.2675, "maximum": 145.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 104.36, "10th_percentile": 104.36, "90th_percentile": 104.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 52.47, "10th_percentile": 52.47, "90th_percentile": 52.47, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.55, "10th_percentile": 50.55, "90th_percentile": 50.55, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 92.84, "10th_percentile": 92.84, "90th_percentile": 92.84, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 114.56, "10th_percentile": 114.56, "90th_percentile": 116.76, "count": "13" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.75 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 33.88, "10th_percentile": 33.38, "90th_percentile": 33.88, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 145.75, "10th_percentile": 145.75, "90th_percentile": 145.75, "count": "118" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 20.26, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 116.5, "10th_percentile": 46.64, "90th_percentile": 133.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 46.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.64, "10th_percentile": 46.64, "90th_percentile": 49.56, "count": "1 through 10" } ] } ] }, { "description": "N-Terminal pro Brain Natriuretic Peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 534.5, "discounted_cash": 155.0, "minimum": 155.005, "maximum": 484.7915, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 382.7, "10th_percentile": 382.7, "90th_percentile": 382.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 192.42, "10th_percentile": 192.42, "90th_percentile": 192.42, "count": "14" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 280.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 343.3 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 274.64 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 185.36, "10th_percentile": 185.36, "90th_percentile": 185.36, "count": "23" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 340.48, "10th_percentile": 340.48, "90th_percentile": 438.29, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 420.12, "10th_percentile": 420.12, "90th_percentile": 428.19, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 363.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 256.56, "10th_percentile": 186.42, "90th_percentile": 534.5, "count": "22" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 534.5, "10th_percentile": 534.5, "90th_percentile": 534.5, "count": "77" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 489.6, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 181.73, "count": "32" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 171.04, "10th_percentile": 171.04, "90th_percentile": 171.04, "count": "25" } ] } ] }, { "description": "Rad Ther Cont Med Rad Physics Consult", "code_information": [ { "code": "77336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 678.75, "discounted_cash": 196.0, "minimum": 196.8375, "maximum": 615.6263, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 253.82 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 311.01 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 248.81 } ] } ] }, { "description": "INJ ANES PERIPH NV FAC", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.25, "discounted_cash": 382.0, "minimum": 382.2925, "maximum": 1195.6527, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1318.25, "10th_percentile": 1318.25, "90th_percentile": 1318.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 421.84, "10th_percentile": 421.84, "90th_percentile": 421.84, "count": "1 through 10" } ] } ] }, { "description": "MOD SED SAME PHYS/QHP <5 YRS FAC", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 513.0, "discounted_cash": 148.0, "minimum": 148.77, "maximum": 465.291, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 513.0, "10th_percentile": 513.0, "90th_percentile": 513.0, "count": "1 through 10" } ] } ] }, { "description": "Lyme Ab Total by ELISA", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 70.0, "minimum": 70.325, "maximum": 219.9475, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 163.79, "10th_percentile": 163.79, "90th_percentile": 163.79, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 87.3, "10th_percentile": 87.3, "90th_percentile": 87.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.57 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 115.65 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 84.1, "10th_percentile": 84.1, "90th_percentile": 84.1, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 145.71, "10th_percentile": 145.71, "90th_percentile": 154.47, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 190.61, "10th_percentile": 190.61, "90th_percentile": 381.21, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.88 }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 177.28, "10th_percentile": 177.28, "90th_percentile": 177.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 242.5, "10th_percentile": 228.75, "90th_percentile": 242.5, "count": "39" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 73.2, "90th_percentile": 77.6, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 209.54, "10th_percentile": 209.54, "90th_percentile": 219.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 77.6, "10th_percentile": 77.6, "90th_percentile": 77.6, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2465.0, "minimum": 2465.91, "maximum": 7060.42, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7060.42 } ] } ] }, { "description": "Urine Potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.5, "discounted_cash": 22.0, "minimum": 22.475, "maximum": 70.2925, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 34.8 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.85 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7397.0, "minimum": 7397.74, "maximum": 21914.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21914.53 } ] } ] }, { "description": "Eye Culture with Gram Stain", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.5, "discounted_cash": 55.0, "minimum": 55.245, "maximum": 172.7835, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 128.7, "10th_percentile": 128.7, "90th_percentile": 128.7, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.58, "10th_percentile": 54.99, "90th_percentile": 68.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 71.06 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 69.66 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 58.61, "10th_percentile": 52.98, "90th_percentile": 66.07, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 114.5, "10th_percentile": 114.5, "90th_percentile": 130.79, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 127.78, "10th_percentile": 127.78, "90th_percentile": 144.0, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 79.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 61.12, "10th_percentile": 50.99, "90th_percentile": 169.0, "count": "1 through 10" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 128.7, "10th_percentile": 44.28, "90th_percentile": 128.7, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 179.75, "10th_percentile": 159.5, "90th_percentile": 190.5, "count": "103" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.88, "10th_percentile": 8.62, "90th_percentile": 97.92, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 153.28, "10th_percentile": 60.96, "90th_percentile": 172.79, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.96, "10th_percentile": 54.96, "90th_percentile": 60.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 157.42, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 54.08, "10th_percentile": 54.08, "90th_percentile": 54.08, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10087.0, "minimum": 10087.83, "maximum": 25793.11, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25793.11 } ] } ] }, { "description": "LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "820", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23986.0, "minimum": 23986.62, "maximum": 69140.01, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69140.01 } ] } ] }, { "description": "MRI Angio Neck w+wo Contrast", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2458.0, "discounted_cash": 712.0, "minimum": 712.82, "maximum": 2458.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2458.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 2135.09 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2295.29 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6725.0, "minimum": 6725.22, "maximum": 17487.77, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17487.77 } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "544", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6052.0, "minimum": 6052.7, "maximum": 12769.713, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8895.96 } ] } ] }, { "description": "Somatostatin Quantitative, Plasma", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 595.25, "discounted_cash": 172.0, "minimum": 136.77, "maximum": 539.8918, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.52 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.96 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.77 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 169.46 } ] } ] }, { "description": "Phosphatidylglycerol Amniotic Fluid", "code_information": [ { "code": "84081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.25, "discounted_cash": 54.0, "minimum": 54.8825, "maximum": 171.6498, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 136.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.08 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 133.66 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 153.15 } ] } ] }, { "description": "IGF Binding Protein-3", "code_information": [ { "code": "82397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.75, "discounted_cash": 35.0, "minimum": 35.3075, "maximum": 121.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 88.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.13 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 86.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.75 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 121.75, "10th_percentile": 121.75, "90th_percentile": 121.75, "count": "1 through 10" } ] } ] }, { "description": "LAC FACE 2.6-5CM FAC", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 115.0, "minimum": 115.42, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 305.66, "10th_percentile": 305.66, "90th_percentile": 305.66, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 143.28, "10th_percentile": 143.28, "90th_percentile": 143.28, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.28, "10th_percentile": 121.28, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.28, "10th_percentile": 121.28, "90th_percentile": 121.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14122.0, "minimum": 14122.96, "maximum": 55424.71, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55424.71 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 9863.66, "maximum": 24589.45, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24589.45 } ] } ] }, { "description": "MRI Neck w Contrast", "code_information": [ { "code": "70542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1947.5, "discounted_cash": 564.0, "minimum": 564.775, "maximum": 1947.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1947.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1694.64 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1694.67 } ] } ] }, { "description": "CT Pelvis w Contrast", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1939.5, "discounted_cash": 562.0, "minimum": 562.455, "maximum": 1759.1265, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 622.12, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1315.68 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1052.54 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 634.56, "10th_percentile": 634.56, "90th_percentile": 634.56, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1528.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 535.64, "10th_percentile": 535.64, "90th_percentile": 1110.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1829.75, "10th_percentile": 1829.75, "90th_percentile": 1939.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 620.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 620.64, "10th_percentile": 620.64, "90th_percentile": 620.64, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7621.0, "minimum": 7621.92, "maximum": 36767.187, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 12862.92, "10th_percentile": 12862.92, "90th_percentile": 12862.92, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "other", "standard_charge_dollar": 36440.37, "standard_charge_algorithm": "89.2% of Billed Charges", "additional_payer_notes": "standard charge dollar calculated based on average charges billed", "median_amount": 13382.36, "10th_percentile": 13382.36, "90th_percentile": 13382.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 7621.92, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 14760.0, "10th_percentile": 14760.0, "90th_percentile": 17220.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14193.93 } ] } ] }, { "description": "BCR-ABL1 Gene Rearrangment, QN, PCR", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1240.25, "discounted_cash": 359.0, "minimum": 355.11, "maximum": 1240.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 362.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 443.88 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 355.11 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1240.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 156.58, "10th_percentile": 156.58, "90th_percentile": 156.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 374.4, "10th_percentile": 374.4, "90th_percentile": 374.4, "count": "1 through 10" } ] } ] }, { "description": "ADAMTS13 Activity", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 606.25, "discounted_cash": 175.0, "minimum": 175.8125, "maximum": 549.8687, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 189.44 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 232.12 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 185.7 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 286.09 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 15422.34, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15422.34 } ] } ] }, { "description": "Aldosterone, Serum", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 464.5, "discounted_cash": 134.0, "minimum": 134.705, "maximum": 421.3015, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 336.36 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 412.16 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 329.73 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 161.09, "10th_percentile": 161.09, "90th_percentile": 161.09, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 377.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 9.27, "10th_percentile": 9.27, "90th_percentile": 464.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 464.5, "10th_percentile": 464.5, "90th_percentile": 464.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 157.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.64, "10th_percentile": 148.64, "90th_percentile": 148.64, "count": "1 through 10" } ] } ] }, { "description": "Estradiol, Ultrasensitive, LC/MS", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.5, "discounted_cash": 81.0, "minimum": 81.345, "maximum": 280.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 230.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 280.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 226.1 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 259.02 } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 21583.26, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21583.26 } ] } ] }, { "description": "Aspergillus Ab-CF", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.25, "discounted_cash": 60.0, "minimum": 60.6825, "maximum": 189.7897, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 121.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 149.07 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 119.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 139.52 } ] } ] }, { "description": "NM Quadramet Therapy", "code_information": [ { "code": "79101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 597.0, "discounted_cash": 173.0, "minimum": 173.13, "maximum": 541.479, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 275.7 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 337.83 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 270.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 454.01 } ] } ] }, { "description": "Hematocrit, Body Fluid", "code_information": [ { "code": "85013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.25, "discounted_cash": 16.0, "minimum": 16.8925, "maximum": 58.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 19.56 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.97 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.25 } ] } ] }, { "description": "Everolimus, Blood", "code_information": [ { "code": "80169", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 802.0, "discounted_cash": 232.0, "minimum": 55.14, "maximum": 727.414, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.14 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 127.28 } ] } ] }, { "description": ".RMSF IgM Titer", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.75, "discounted_cash": 110.0, "minimum": 110.7075, "maximum": 346.2473, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 159.76 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 195.76 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 156.61 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 179.38 } ] } ] }, { "description": "Hgb Elect", "code_information": [ { "code": "83021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.25, "discounted_cash": 23.0, "minimum": 23.8525, "maximum": 82.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 217.5, "10th_percentile": 217.5, "90th_percentile": 217.5, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 197.27, "10th_percentile": 197.27, "90th_percentile": 199.23, "count": "1 through 10" } ] } ] }, { "description": "FAC ART CATH SMPL TRN", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1880.0, "discounted_cash": 545.0, "minimum": 545.2, "maximum": 1705.16, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 1880.0, "10th_percentile": 1880.0, "90th_percentile": 1880.0, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17709.0, "minimum": 17709.75, "maximum": 41490.14, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41490.14 } ] } ] }, { "description": "MRI Angio Spine w+wo Contrast 72159", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1827.5, "discounted_cash": 529.0, "minimum": 529.975, "maximum": 1827.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1827.5 } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13226.0, "minimum": 13226.27, "maximum": 84594.18, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84594.18 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7173.0, "minimum": 7173.57, "maximum": 23580.32, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23580.32 } ] } ] }, { "description": "88332 AP Bill Frozen addl block", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.75, "discounted_cash": 33.0, "minimum": 33.2775, "maximum": 114.75, "payers_information": [ { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.75 } ] } ] }, { "description": "MRI TM Joints Bilat wo 70336", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 918.75, "discounted_cash": 266.0, "minimum": 266.4375, "maximum": 918.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 918.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 918.75 }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 918.75 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5828.0, "minimum": 5828.52, "maximum": 10917.0708, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 6090.81, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 6153.55, "10th_percentile": 6153.55, "90th_percentile": 6153.55, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9938.11 } ] } ] }, { "description": "VAP Triglyceride", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.75, "discounted_cash": 35.0, "minimum": 35.8875, "maximum": 112.2412, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 47.49 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.19 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.8, "10th_percentile": 46.5, "90th_percentile": 123.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 5.74, "10th_percentile": 5.74, "90th_percentile": 5.74, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 5.74, "10th_percentile": 5.74, "90th_percentile": 39.6, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 39.6, "10th_percentile": 39.6, "90th_percentile": 42.08, "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": 28.0, "minimum": 28.855, "maximum": 99.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 99.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 85.45 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.5 } ] } ] }, { "description": "Protein S Antigen, Total and Free", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.5, "discounted_cash": 16.0, "minimum": 16.095, "maximum": 55.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.5 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "959", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8518.0, "minimum": 8518.61, "maximum": 34707.94, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34707.94 } ] } ] }, { "description": "75822 FAC VENOGRAPHY EXT BILATERAL", "code_information": [ { "code": "75822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2650.75, "discounted_cash": 768.0, "minimum": 360.39, "maximum": 2404.2303, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 367.64 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.49 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 360.39 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 555.49 } ] } ] }, { "description": "Chemo Administration IV Push Single", "code_information": [ { "code": "96409", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.75, "discounted_cash": 121.0, "minimum": 121.4375, "maximum": 379.8062, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 418.75, "10th_percentile": 418.75, "90th_percentile": 418.75, "count": "1 through 10" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 20783.97, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20783.97 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 7450.64, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7450.64 } ] } ] }, { "description": "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50214.0, "minimum": 50214.98, "maximum": 163293.88, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 163293.88 } ] } ] }, { "description": "Injection Therapy SC/IM", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.25, "discounted_cash": 39.0, "minimum": 39.2225, "maximum": 122.6718, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 387.36, "10th_percentile": 119.21, "90th_percentile": 387.36, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.69, "10th_percentile": 48.69, "90th_percentile": 48.69, "count": "15" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "percent of total billed charges", "standard_charge_percentage": 64.04, "median_amount": 88.28, "10th_percentile": 86.61, "90th_percentile": 88.28, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 46.91, "10th_percentile": 46.91, "90th_percentile": 88.28, "count": "17" }, { "payer_name": "Multiplan", "plan_name": "Multiplan", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.0, "median_amount": 119.21, "10th_percentile": 119.21, "90th_percentile": 129.04, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 135.25, "10th_percentile": 135.25, "90th_percentile": 135.25, "count": "48" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 129.84, "count": "86" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 86.56, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 86.56, "count": "49" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 43.28, "10th_percentile": 43.28, "90th_percentile": 45.99, "count": "20" } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8966.0, "minimum": 8966.96, "maximum": 17663.43, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17663.43 } ] } ] }, { "description": "MRI Breast Bx Clip Perc EA Add Lesion 19288", "code_information": [ { "code": "19288", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2042.5, "discounted_cash": 592.0, "minimum": 592.325, "maximum": 1852.5475, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 } ] } ] }, { "description": "Mycobacteria ID using 16S DNA Sequencing", "code_information": [ { "code": "87153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.75, "discounted_cash": 195.0, "minimum": 195.0975, "maximum": 672.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 672.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 672.75 } ] } ] }, { "description": "$ Acid EP", "code_information": [ { "code": "83020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.5, "discounted_cash": 54.0, "minimum": 54.085, "maximum": 169.1555, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 104.18 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.31 } ] } ] }, { "description": "Alpha-1 Antitrypsin Phenotype", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.75, "discounted_cash": 84.0, "minimum": 84.0275, "maximum": 262.8032, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 222.53, "10th_percentile": 222.53, "90th_percentile": 222.53, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 119.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 146.23 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 116.98 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.05 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 289.75, "10th_percentile": 289.75, "90th_percentile": 289.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 92.72, "10th_percentile": 92.72, "90th_percentile": 265.41, "count": "1 through 10" } ] } ] }, { "description": "XR TM Joints Bilateral", "code_information": [ { "code": "70330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 617.5, "discounted_cash": 179.0, "minimum": 135.84, "maximum": 560.0725, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 138.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 169.81 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 135.84 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 352.46 } ] } ] }, { "description": "TAP LUMBAR SPINE DX FAC", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.75, "discounted_cash": 220.0, "minimum": 220.0375, "maximum": 688.1862, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 758.75, "10th_percentile": 758.75, "90th_percentile": 758.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 231.2, "10th_percentile": 231.2, "90th_percentile": 231.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 231.2, "10th_percentile": 231.2, "90th_percentile": 231.2, "count": "1 through 10" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4035.0, "minimum": 4035.13, "maximum": 7855.0, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7855.0 } ] } ] }, { "description": "PT Evaluation Units, High Complexity", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.75, "discounted_cash": 122.0, "minimum": 95.0, "maximum": 381.6202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 151.47, "10th_percentile": 151.47, "90th_percentile": 151.47, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" } ] } ] }, { "description": "XR Elbow Left Min 3 Views", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426.75, "discounted_cash": 123.0, "minimum": 100.12, "maximum": 387.0623, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 144.9, "10th_percentile": 144.9, "90th_percentile": 153.63, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 102.13 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.15 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 100.12 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 148.0, "10th_percentile": 139.59, "90th_percentile": 148.0, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 271.84, "10th_percentile": 271.84, "90th_percentile": 341.83, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.63 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 426.75, "10th_percentile": 402.5, "90th_percentile": 426.75, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.85, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 387.06, "10th_percentile": 387.06, "90th_percentile": 387.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 128.8, "90th_percentile": 148.93, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.56, "10th_percentile": 136.56, "90th_percentile": 136.56, "count": "1 through 10" } ] } ] }, { "description": "Iron Sucrose Inj 20 MG/ML (Fe Equiv)", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00517234001", "type": "NDC" }, { "code": "J1756", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 190.32, "10th_percentile": 190.32, "90th_percentile": 190.32, "count": "1 through 10" } ] } ] }, { "description": "$ Streptozyme Titer", "code_information": [ { "code": "86406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.5, "discounted_cash": 22.0, "minimum": 22.765, "maximum": 78.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 78.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 78.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.5 } ] } ] }, { "description": "NM Bone Marrow Scan Limited", "code_information": [ { "code": "78102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.25, "discounted_cash": 189.0, "minimum": 189.7325, "maximum": 654.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 526.65 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.32 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 516.26 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 654.25 } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13002.0, "minimum": 13002.09, "maximum": 49381.68, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49381.68 } ] } ] }, { "description": ".CD4 Absolute Count Only", "code_information": [ { "code": "86361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.75, "discounted_cash": 73.0, "minimum": 73.5875, "maximum": 248.264, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 90.79 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.25 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 89.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 248.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 212.75, "10th_percentile": 212.75, "90th_percentile": 212.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 68.08, "10th_percentile": 68.08, "90th_percentile": 68.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 64.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 64.24, "10th_percentile": 64.24, "90th_percentile": 68.08, "count": "1 through 10" } ] } ] }, { "description": "E.coli 0157 Latex (oxoid)", "code_information": [ { "code": "87335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.0, "discounted_cash": 8.0, "minimum": 8.7, "maximum": 30.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 12.66, "10th_percentile": 12.66, "90th_percentile": 12.66, "count": "1 through 10" } ] } ] }, { "description": "RPR Quantitative Titer", "code_information": [ { "code": "86593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.75, "discounted_cash": 19.0, "minimum": 19.0675, "maximum": 59.6352, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 36.35 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.54 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 35.63 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.79 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 4.4, "10th_percentile": 4.4, "90th_percentile": 4.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 19.84, "10th_percentile": 19.84, "90th_percentile": 19.84, "count": "1 through 10" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 3810.0, "minimum": 3810.96, "maximum": 20328.92, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20328.92 } ] } ] }, { "description": "Cystic Fibrosis (CFTR) 165 Pathogenic Variants.", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 680.5, "discounted_cash": 197.0, "minimum": 197.345, "maximum": 680.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 680.5 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 680.5 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9639.0, "minimum": 9639.48, "maximum": 31249.05, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31249.05 } ] } ] }, { "description": "Beta Lactamase", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 8.0, "minimum": 8.99, "maximum": 31.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 29.25, "10th_percentile": 29.25, "90th_percentile": 31.0, "count": "1 through 10" } ] } ] }, { "description": "PNEUMOTHORAX WITH CC", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6949.0, "minimum": 6949.39, "maximum": 12959.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12959.63 } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 36043.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36043.63 } ] } ] }, { "description": "B-Cell Receptor IGH Gene Rearrangement, PCR", "code_information": [ { "code": "81261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 700.0, "discounted_cash": 203.0, "minimum": 203.0, "maximum": 700.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 700.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 700.0 } ] } ] }, { "description": "Lactate", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 139.0, "discounted_cash": 40.0, "minimum": 40.31, "maximum": 126.073, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 99.52, "10th_percentile": 99.52, "90th_percentile": 99.52, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 50.04, "10th_percentile": 50.04, "90th_percentile": 50.04, "count": "11" }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.99 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 86.39 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 48.21, "10th_percentile": 48.21, "90th_percentile": 96.41, "count": "22" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 113.98, "10th_percentile": 111.34, "90th_percentile": 227.96, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 111.35, "10th_percentile": 109.25, "90th_percentile": 218.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 139.0, "10th_percentile": 20.26, "90th_percentile": 278.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 139.0, "10th_percentile": 139.0, "90th_percentile": 139.0, "count": "113" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "47" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 88.96, "10th_percentile": 44.48, "90th_percentile": 127.32, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "36" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 88.96, "count": "42" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 44.48, "10th_percentile": 44.48, "90th_percentile": 47.26, "count": "12" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8742.0, "minimum": 8742.79, "maximum": 17354.56, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17354.56 } ] } ] }, { "description": "CT SI Joint Nerve Inj 64451", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2406.75, "discounted_cash": 697.0, "minimum": 650.0, "maximum": 2182.9223, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 650.0 } ] } ] }, { "description": "Thyroid Stimulating Immunoglobulin", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 440.5, "discounted_cash": 127.0, "minimum": 127.745, "maximum": 440.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 158.58, "10th_percentile": 158.58, "90th_percentile": 158.58, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 419.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 440.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 411.41 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 152.77, "10th_percentile": 152.77, "90th_percentile": 152.77, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 280.6, "10th_percentile": 280.6, "90th_percentile": 280.6, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.5 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 440.5, "10th_percentile": 440.5, "90th_percentile": 440.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.96, "10th_percentile": 140.96, "90th_percentile": 140.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 399.53, "10th_percentile": 399.53, "90th_percentile": 399.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 140.96, "10th_percentile": 140.96, "90th_percentile": 140.96, "count": "1 through 10" } ] } ] }, { "description": "Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.5, "discounted_cash": 44.0, "minimum": 44.515, "maximum": 139.2245, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 56.25 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.92 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 55.14 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 53.23, "10th_percentile": 53.23, "90th_percentile": 53.23, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 153.5, "10th_percentile": 153.5, "90th_percentile": 153.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 6.82, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 49.12, "10th_percentile": 49.12, "90th_percentile": 49.12, "count": "1 through 10" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10760.0, "minimum": 8784.8934, "maximum": 22900.09, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "other", "standard_charge_dollar": 11244.58, "standard_charge_algorithm": "2342.62 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 8859.86, "10th_percentile": 8859.86, "90th_percentile": 8859.86, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 10760.35, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 2143.82, "10th_percentile": 2143.82, "90th_percentile": 24670.44, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22900.09 } ] } ] }, { "description": "OT Eval Mod Complex", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.5, "discounted_cash": 145.0, "minimum": 95.0, "maximum": 454.8605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 180.54, "10th_percentile": 180.54, "90th_percentile": 180.54, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 69.39, "10th_percentile": 69.39, "90th_percentile": 69.39, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 37.11, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 160.48, "10th_percentile": 160.48, "90th_percentile": 160.48, "count": "1 through 10" } ] } ] }, { "description": "XR Arthrogram Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 578.25, "discounted_cash": 167.0, "minimum": 167.6925, "maximum": 578.25, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 316.55 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 387.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 310.31 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 578.25 } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 13857.95, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13857.95 } ] } ] }, { "description": "Mycophenolic Acid Level", "code_information": [ { "code": "80180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.0, "discounted_cash": 53.0, "minimum": 53.94, "maximum": 170.61, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 139.24 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 170.61 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 136.49 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.33 } ] } ] }, { "description": "Reticulocyte, %", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.75, "discounted_cash": 29.0, "minimum": 29.7975, "maximum": 93.1942, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 33.07 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.52 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 32.42 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 33.64, "10th_percentile": 33.64, "90th_percentile": 35.64, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.99 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 97.0, "10th_percentile": 97.0, "90th_percentile": 102.75, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 31.04, "90th_percentile": 32.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 31.04, "10th_percentile": 31.04, "90th_percentile": 93.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 32.88, "90th_percentile": 32.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.88, "10th_percentile": 32.88, "90th_percentile": 32.98, "count": "1 through 10" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 32.98, "10th_percentile": 31.04, "90th_percentile": 32.98, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4483.0, "minimum": 4483.48, "maximum": 22566.47, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22566.47 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8070.0, "minimum": 8070.26, "maximum": 19986.8549, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 27298.88, "10th_percentile": 27298.88, "90th_percentile": 27298.88, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "other", "standard_charge_dollar": 8070.26, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9840.0, "10th_percentile": 9840.0, "90th_percentile": 9840.0, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12036.55 } ] } ] }, { "description": "SIM REP TRK 7.6-12.5 FAC", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.0, "discounted_cash": 115.0, "minimum": 115.42, "maximum": 360.986, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.44, "10th_percentile": 136.44, "90th_percentile": 136.44, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 131.44, "10th_percentile": 131.44, "90th_percentile": 131.44, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 398.0, "10th_percentile": 379.0, "90th_percentile": 398.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 121.28, "10th_percentile": 121.28, "90th_percentile": 127.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 127.36, "10th_percentile": 127.36, "90th_percentile": 127.36, "count": "1 through 10" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10536.0, "minimum": 10536.18, "maximum": 49155.33, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49155.33 } ] } ] }, { "description": "MRI Breast Right w Contrast 77048", "code_information": [ { "code": "77048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 939.0, "discounted_cash": 272.0, "minimum": 272.31, "maximum": 939.0, "payers_information": [ { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 900.0 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 939.0 } ] } ] }, { "description": "Aspergillus galactomannan Ag, Serum", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 420.5, "discounted_cash": 121.0, "minimum": 92.71, "maximum": 381.3935, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 94.58 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.89 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 92.71 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 111.06 } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20399.0, "minimum": 20399.83, "maximum": 53624.53, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53624.53 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9191.0, "minimum": 9191.13, "maximum": 11092.25, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11092.25 } ] } ] }, { "description": "NM Thyroid Image Only", "code_information": [ { "code": "78013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.75, "discounted_cash": 189.0, "minimum": 189.8775, "maximum": 654.75, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 643.34 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 654.75 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 630.65 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 654.75 } ] } ] }, { "description": "OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9863.0, "minimum": 7613.4087, "maximum": 21585.62, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "other", "standard_charge_dollar": 9863.66, "standard_charge_algorithm": "2241.74 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9749.6, "10th_percentile": 9749.6, "90th_percentile": 9749.6, "count": "1 through 10" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21585.62 } ] } ] }, { "description": "NM VCUG", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 803.5, "discounted_cash": 233.0, "minimum": 233.015, "maximum": 803.5, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 691.48 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 803.5 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 677.83 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 803.5 } ] } ] }, { "description": "XR Foot Left 3 Views", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.5, "discounted_cash": 113.0, "minimum": 84.38, "maximum": 355.9975, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 76.8, "median_amount": 265.1, "10th_percentile": 265.1, "90th_percentile": 265.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 141.3, "10th_percentile": 133.29, "90th_percentile": 141.3, "count": "1 through 10" }, { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 86.08 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.47 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 84.38 }, { "payer_name": "Anthem", "plan_name": "Anthem Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 136.12, "10th_percentile": 136.12, "90th_percentile": 136.12, "count": "1 through 10" }, { "payer_name": "Cigna Commercial", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 63.7, "median_amount": 303.6, "10th_percentile": 250.02, "90th_percentile": 314.39, "count": "1 through 10" }, { "payer_name": "Community Health Options", "plan_name": "Community Health Options", "methodology": "percent of total billed charges", "standard_charge_percentage": 78.6, "median_amount": 308.51, "10th_percentile": 296.61, "90th_percentile": 308.51, "count": "1 through 10" }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 222.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.89, "10th_percentile": 125.6, "90th_percentile": 392.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.31, "median_amount": 392.5, "10th_percentile": 370.25, "90th_percentile": 392.5, "count": "91" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.6, "count": "28" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 90.7, "median_amount": 339.15, "10th_percentile": 125.6, "90th_percentile": 356.0, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 231.88, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC VACCN", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 125.6, "90th_percentile": 125.89, "count": "11" }, { "payer_name": "Wellcare", "plan_name": "Wellcare Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 29.0, "median_amount": 125.6, "10th_percentile": 118.48, "90th_percentile": 125.89, "count": "17" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC", "code_information": [ { "code": "660", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6276.0, "minimum": 6276.87, "maximum": 15581.49, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15581.49 } ] } ] }, { "description": "XR SMB Via Enteroclysis", "code_information": [ { "code": "74251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1105.0, "discounted_cash": 320.0, "minimum": 320.45, "maximum": 1105.0, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 577.69 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 707.87 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 566.3 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1105.0 } ] } ] }, { "description": "Myco. tb Amplified Direct Detection", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 393.0, "discounted_cash": 113.0, "minimum": 113.97, "maximum": 386.3944, "payers_information": [ { "payer_name": "Anthem", "plan_name": "Anthem Bowdoin College Health Plan", "methodology": "fee schedule", "standard_charge_dollar": 214.99 }, { "payer_name": "Anthem", "plan_name": "Anthem HMO POS PPO", "methodology": "fee schedule", "standard_charge_dollar": 263.43 }, { "payer_name": "Anthem", "plan_name": "Anthem MaineHealth Partners Health Plans", "methodology": "fee schedule", "standard_charge_dollar": 210.75 }, { "payer_name": "Harvard Pilgrim", "plan_name": "Harvard Pilgrim Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.39 } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5380.0, "minimum": 5380.18, "maximum": 22503.98, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22503.98 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 2690.0, "minimum": 2690.09, "maximum": 22903.63, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22903.63 } ] } ] }, { "description": "RECTAL RESECTION WITHOUT CCMCC", "code_information": [ { "code": "334", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4931.0, "minimum": 4931.83, "maximum": 19309.17, "payers_information": [ { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19309.17 } ] } ] } ] }